|
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oo.
OF THE
U. S. DEPARTMENT OF
_ HEALTH, EDUCATION, 2 and WELFARE
1954
RECEIVED
OCT 26 1955
K. F. G,
nnual
eport
OF THE
U. S. DEPARTMENT OF
HEALTH, EDUCATION, and WELFARE
es,
pm tg Re ee
For sale by the Superintendent“of Documents, U. 8S. Government Printing Office
Washington"25, D. C. = Price 75 cents
HO F102
4
1954
U. S. DEPARTMENT OF
HEALTH, EDUCATION, AND WELFARE
' As of March 1955
OvETA CuLP Hossy, Secretary
Vacancy, Under Secretary
OFFICE OF THE SECRETARY
RoswELL B. PERKINS ....... Assistant Secretary for Program Analysis.
BraDSHAW MINTENER...... . Assistant Secretary for Federal-State Rela-
tions.
CHESTER S. KEEFER ........ - Special Assistant for Health and Medical
Affairs.
DonaLpD M. COUNIHAN....... Legislative Liaison Officer.
TERENCE P. SOANTLEBURY ..... Executive Secretary.
WILLIAM C. McCAMANT...... Assistant to the Secretary.
PARKE Mic BANTA 35 cis hee eee General Counsel.
Rurus E. MILES, JR........ - Comptroller.
ForDYOE LUIKART ......... - Director of Administration.
Ropert J. DECAMP......... Director of Field Administration. :
J. STEWART HUNTER........ Acting Director of Publications and Reports.
FREDERICK H. SCHMIDT...... Director of Security.
SOCIAL SECURITY ADMINISTRATION
CHARLES I. SCHOTTLAND...... Commissioner of Social Security.
Witriam L. MITCHELL ....... Deputy Commissioner of Social Security.
Vicrok CHRISTGAU..... Director, Bureau of Old-Age and Surviwors
Insurance.
JAY (LE RONBY 2 gua caae kets Director, Bureau of Public Assistance.
J. DEANE GANNON..... Director, Bureau of Federal Credit Unions.
MartHa M. Exitor..... Chief, Children’s Bureau.
PUBLIC HEALTH SERVICE
LEoNaRD A. SCHEELE ........ Surgeon General.
W. PALMER DEARING........ Deputy Surgeon General.
JACK ; MASUR. 20.4... Chief, Bureau of Medical Services.
CHARLES E. BURBRIDGE .. . Superintendent, Freedmen’s Hospital.
Otis L. ANDERSON ..... Chief, Bureau of State Services.
WILLIAM H. SEBRELL, JR. . . Director, National Institutes of Health.
OFFICE OF EDUCATION
SAMUEL M. BROWNELL ....... Commissioner of Education.
J. KENNETH LITTLE ........ Deputy Commissioner of Education.
ii
FOOD AND DRUG ADMINISTRATION
GEORGE P. LARRIOK ........-. Commissioner of Food and Drugs.
ima SAARVEY. 00608 6 we ee Deputy Commissioner of Food and Drugs.
OFFICE OF VOCATIONAL REHABILITATION
Meee. SWITZER... ew Director of Vocational Rehabilitation.
Emory E. FEREBEE......... Deputy Director of Vocational Rehabilitation.
SAINT ELIZABETHS HOSPITAL
WINFRED OVERHOLSER....... Superintendent.
mOnIsSON M. DUVALL... ........ Assistant Superintendent.
FEDERALLY AIDED CORPORATIONS
PangeeWAVI8 . 2. oe we *,... Superintendent, American Printing House for
the Blind.
Lronarp M. EBLstap........ President, Gallaudet College.
MorpEecal W. JOHNSON...... President, Howard University.
REGIONAL DIRECTORS
LAWRENCE J. BRESNAHAN..... Region I, Boston, Mass.
JOSEPH B. O’CONNOR........ Region II, New York, N. Y.
Micuaet J. SHortteYy....... Region III, Washington, D. C.
erOraep OH. LYLE... .. ss ees Region IV, Atlanta, Ga.
MELVILLE H. Hoscu (Acting) .. Region V, Chicago, Ill.
JAMES W. DOARN.......... Region VI, Kansas City, Mo.
eee tte OND . 4. eee ee Region VII, Dallas, Tex.
ALBERT H. ROSENTHAL ....... Region VIII, Denver, Colo.
Pee EPONTER 4. 5. 1 ee ek Region IX, San Francisco, Calif.
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Letter of Transmittal
DEPARTMENT OF HeautrH, Epucarion, AND WELFARE,
Washington, D. C., December 1, 1954.
Dear Mr. Presipent: I have the honor to submit herewith the
annual report of the Department of Health, Education, and Welfare
for the fiscal year ending June 30, 1954.
Respectfully,
Odie RapMore =
Secretary.
THE PRESIDENT,
Tue Waite Hovss,
Washington, D.C.
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Contents
Meee ecretarys Report... . 2... we es
Social Security Administration .........
Meeeiedilp Service’... 6. ee
Office RMBPOHGCOIOI Ia.) . ca 8628 Re ee ts
Food and Drug Administration .
Office of Vocational Rehabilitation... ....
meat Plizabeths Hospital... . 66%. ew a
American Printing House for the Blind ....
BE TRC Oiler e ee ee
MER ITIIVETSULY (1's ee ees
A detailed listing of the contents of this report, by
topic headings, will be found on pages 271-278
vii
“
pata
The Secretary's
Report
Tue FEDERAL GOVERNMENT’s activities in health, education, and wel-
fare are both a product and an instrument of modern American
society.
As a product, these activities have evolved from the development of
a vast virgin land into a highly complex, industrial society. As an
instrument, they are used as the modern means of furthering individ-
ual independence and dignity and of advancing national strength and
vigor.
The economic and social development of America is dated, of course,
from the first settlements in the New World. As in other societies,
America progressed through the social unit of the “community.” As
a sparsely settled wilderness, the people’s strength and means of prog-
ress lay in the frontier stockades and settlements, which were forever
pushed onward until the land was conquered.
Political independence, growth, and change gave new dimensions
to the community. States, as political entities, were formed as ex-
tensions of their communities’ interests. And the National Govern-
ment, as a political entity of the whole, was created to represent the
national interest of all the individual communities.
Time has not diminished the contribution to life today of our
earliest communities, nor has it erased the hard core meaning and
strength today of the individual American community.
In one form or another—sometimes in almost indiscernable shape,
sometimes in clear outline and principle—today’s public activities
in health, education, and welfare had their origins in the earliest
settlements and colonial period of America.
In some of the earliest settlements, where famine was a major
hazard, a portion of the crops was set aside in a community store-
house for those in need during winter food shortages. Epidemics of
!
2 Department of Health, Education, and Welfare, 1954
communicable diseases were treated in many communities as a com-
munity responsibility, and “boards of quarantine” were established
at ports to prevent the importation of disease from abroad. The
earliest educational endeavors in America, from the “grammar”
school in New England to the “old field” school in the South, con-
tained the germ of the principle of “free” instruction for all children
as a community responsibility.
As the American economy developed, as our population grew, as
the social aspects of life changed, so development, growth, and change
have been necessary and desirable in our public activities in health,
education, and welfare. In these activities, as in other fields, growth
and change have been the orderly expectation of life in America.
The America we know today, in all its aspects, has been most in-
fluenced by a historical fact marked by the year 1776. For our free-
dom as a people, as exercised through our democratic processes, has
been the synthesizing and catalytic agent which has given our Nation
its particular form, including our concepts and endeavors in public
health, education, and welfare.
Our independence as a people had hardly been won and the Fed-
eral Union formed before the national interest in education was dem-
onstrated. In 1785 the first Federal grant of any nature was initiated
by reserving land for establishing public schools in the Northwest .
Territory. |
A few years later, in 1798, the Federal Government established th
Marine Hospital Service for the care of American seamen. This hos-
pital service was the forerunner of the Public Health Service.
A form of social security can be identified as far back as 1857, when
the first municipal pension fund was established, providing disa-
bility and death benefits for New York City police.
A few years later the first State gave formal recognition to the
common nature of the problem of needy people and the common re-
sponsibilityof all its communities in this problem. This was marked
in 1863 by the founding in Massachusetts of the first State board of
charities in America.
These were a few of the early stirrings in health, education, and
welfare, which were to grow and change to serve the needs of a people
and nation as they grew and changed.
A hundred years ago our population was about 23 million. At the
end of calendar year 1954 it was nearly 164 million. A hundred years
ago the value of all goods produced and services performed by the
American people in one year was less than $10 billion. For 1954 it
was about $357 billion. A hundred years ago the number of people
employed in America was less than 8 million. At the end of 1954,
the total was well over 60 million.
The Secretary’s Report 3
These few comparisons—of population, value of the national prod-
uct, and employment—indicate growth in only its broadest and sim-
plest form. But they imply a-great deal more. Along with sheer
growth has come social change—the way in which we live our daily
lives.
What are some of the implications, in today’s terms, of these social
changes in relation to the Nation’s health, education, and welfare?
And, more specifically, in the fact of today’s needs, what were some
of the accomplishments in Federal activities in these fields during the
brief span covered by this report, from July 1953 through June 1954 %
The Department and Its Work
The Department of Health, Education, and Welfare is sometimes
referred to as the “Department of Human Resources.”
The activities of the Department touch the life of every man,
woman, and child in America. It is true that all Federal activities
have a direct or indirect bearing on the lives of all Americans. But
health, education, and welfare are intimate elements of the daily lives
of all people.
The Department comprises five major units: The Public Health
Service, Social Security Administration, Office of Education, Food
and Drug Administration, and Office of Vocational Rehabilitation.
It is through the activities of these units that the Department, in
carrying out the laws of Congress, seeks to advance the health of the
Nation, further the education of each succeeding generation, and
strengthen the welfare, or security, of certain, individuals and, hence,
of all Americans.
It is noteworthy that the great bulk of the Department’s work 1s
carried on in partnership with the States and communities. Nearly
all the programs for which the Department has Federal responsibility
are actually operated by the States. One measure of the extent to
which this is true is found in the amount of money spent by the De-
partment in administering wholly Federal activities as against the
amount allocated States for operating State programs to which the
Federal Government makes financial contributions.
For the fiscal year 1954, Congress appropriated $1.9 billion to the
Department for all its activities, except for the self-supporting sys-
tem of Federal old-age and survivors insurance. This amount was
2.8 percent of the total funds spent by the National Government.
About 93 cents of each dollar appropriated by Congress to the De-
partment was passed on by the Department to the States, communi-
ties, and institutions, primarily for their use in providing the various
cash benefits and services in which the Federal Government and the
4. Department of Health, Education, and Welfare, 1954
ia ee cee hat ehh ss nee sd Nena AEE Tl
States jointly cooperate. The remaining 7 cents of each dollar was
spent directly by the Department for all its other activities.
In a broad sense, the term “health” covers the work of the Public
Health Service, Food and Drug Administration, and Office of Vo-
cational Rehabilitation. But activities in food and drugs and in
vocational rehabilitation also involve direct economic factors for the
public. |
Through the Public Health Service, the Department cooperates
with the States in the control of epidemics, the sanitation of milk and
water supplies, control of communicable diseases, and other health
programs. The National Institutes of Health, a branch of the Public
Health Service, conduct research programs in cancer, mental health,
heart disease, dental health, arthritis and metabolic diseases, micro-
biology, and neurological diseases and blindness. The Public Health
Service also facilitates research through grants of funds to universi-
ties, hospitals, and other research organizations. The Department,
through the Public Health Service, also provides funds to assist the
States and communities in the construction of hospitals.
The health of the Nation is further protected and promoted by the
Department’s Food and Drug Administration, which enforces Federal]
laws designed to insure the purity and truthful labeling of foods,
drugs, and cosmetics. In addition, under these laws, the Food and
Drug Administration formulates definitions and standards for foods
to promote honesty and fair dealings in the economic interest of the
consumer.
Health and economic benefits are the twin elements of the program
administered by the Department’s Office of Vocational Rehabilita-
tion. The activities in this field, which are carried on in cooperation
with the States, are designed to restore to useful employment disabled
civilians who have job handicaps resulting from illness, accidents, or
other causes. In addition to the advantages afforded disabled persons
through this program, it works to the economic advantage of the coun-
try. o6¢
INCREASE (__
OLD BENEFIT =)
RETIRED RETIRED WIDOW &
WORKER COUPLE 2 CHILDREN
ALONE
AVERAGE MONTHLY BENEFITS
benefit—at or near the maximum—not because their earnings were
the same, but because their earnings exceeded the maximum that could
be counted under the system. In 19388 only 6 percent of the men
working regularly in covered employment had earnings in excess of
the amount that could be credited for Social Security. By 1953 this
proportion had risen to over 60 percent, even though the earnings
base had been increased in 1950 from $3,000 to $3,600 a year. With
the earnings base raised to $4,200, the proportion of regularly em-
ployed men with earnings in excess of the creditable maximum will
drop to 48 percent, roughly restoring the relationship established at
the time of the 1950 amendments. The increased earnings base will
allow for more significant variation of benefit amounts with earnings.
3. Dropout of low earnings years from the computation of average
earnings.—The new legislation provides for omitting up to 5 years of
low earnings from the computation of the average monthly wage, on
which benefits are based. This amendment will protect newly covered
workers from having their benefits reduced on account of their prior
Social Security Administration 33
years of noncoverage. Equally important, it will give those previ-
ously covered the advantage of some future protection against lower-
ing the average monthly wage because of periods of unemployment,
short-term illness, or low earnings. With extension of coverage, most
workers will have all their earnings (up to the maximum) counted
for benefit purposes. When, in addition, low earnings are dropped
out, there will be relatively few instances in which regularly employed
workers will be having their benefits based on average earnings of
less than $100 a month.
4. A new benefit formula—The newly enacted benefit formula,
applicable to the average of a worker’s monthly earnings after low
earnings years have been excluded, is 55 percent of the first $110 of
average earnings plus 20 percent of the next $240. This replaces the
old formula of 55 percent of the first $100 plus 15 percent of the next
$200. Monthly retirement benefits under the revised formula will
range from $30 to $108.50.
Both lower paid and average income workers today are earning
much higher money wages than in the past. With the benefit formula
adjusted to yield a higher percentage replacement on higher money
earnings, the relative degree of protection such workers can expect in
the form of benefits from the old-age and survivors insurance system
will be maintained.
5. Amended family benefit and lump-sum provisions —Maximum
monthly family benefits are raised from $168.75 to $200. Where fam-
ily benefits must be reduced to bring them within the limitation of
80 percent of the worker’s average monthly earnings, provision is
made that total benefits shall not be reduced below $50 or 114 times
the worker’s benefit amount whichever is larger. ‘The lump-sum death
payment will continue to be computed at 3 times the worker’s benefit,
except that it may not exceed $255.
THE RETIREMENT TEST
The 1954 amendments significantly change the form of the retire-
ment test under the old-age and survivors insurance program. The
new test is put on an annual basis for wage earners as well as for self-
employed. Beginning with 1955, the monthly test for wage earners
is abolished and beneficiaries who work may earn up to $1,200 in a
year without having their benefits suspended. For each $80, or part
of $80, earned in excess of $1,200, one month’s benefit will be suspended.
Benefits will not be suspended, though, for any month in which the
beneficiary neither earned wages of more than $80 nor rendered sub-
stantial services as a self-employed person. In applying the test,
wage and self-employment earnings are combined, and for the first
time earnings from noncovered work as well as covered work are
taken into account. A special test is applicable for beneficiaries en-
34. Department of Health, Education, and Welfare, 1954
gaged in noncovered work outside the United States. The age at
which benefits are paid irrespective of earnings from work is reduced
from 75 to 72. 3
With the test on an annual basis retired beneficiaries will feel freer
to take employment on a part-time or short-term basis, since the
relatively small amount of earnings they gain from such work will
not result in a complete loss of social security benefits. Under the
former monthly test, where benefits were withheld for any month in
which covered wages exceeded $75, beneficiaries were often restricted
in the work they could take and still receive benefits.
The amendments also correct certain other anomalies in the opera-
tion of the test. Thus, by combining wage and self-employment earn-
ings in applying the test, the dual exemption formerly possible for
persons with both types of income is eliminated. Extension of the
test to earnings in noncovered work, and application of a test to non-
covered work outside the United States, puts all beneficiaries on a
substantially equal basis with respect to the conditions under which
they may draw their benefits.
DISABILITY “FREEZE”
The 1954 amendments include a provision that will protect the
benefit rights of workers and their families during periods when the
worker is under a long-term total disability. A serious deficiency in
the old law was its failure to protect the old-age and survivors in-
surance benefit rights of workers and their families during periods of
the worker’s total disability. Under the old law the average monthly
wage (on which benefits are based) had to be figured over the full
time from a specified starting date until the worker became 65 years
of age or died, so that periods during which a worker was out of
employment by reason of disability caused his average earnings, and
therefore his potential benefit, to be reduced. It was even possible,
under the old law, for the worker and his family to lose the right to
any benefits at all because of a long-continued disability which oc-
curred before his retirement age.
Under the amendments if a worker becomes totally disabled and
the disability is expected to be of long-continued and indefinite dura-
tion he will be able to apply, after January 1, 1955, to have his earnings
record “frozen” while he is unable to work. This provision is anal-
ogous to the “waiver of premium” commonly used in life insurance
and endowment annuity policies to maintain the protection of these
policies for the duration of the policyholder’s disability. It has been
estimated that about half of the standard ordinary life insurance
issued currently is protected through “waiver of premium” in the
event of disability of the insured.
Social Security Administration 35
The advantages of the disability freeze provision are available not
only to persons becoming disabled in the future, but also to old-age
insurance beneficiaries who were totally disabled for an extended
period before they retired and who are still disabled. Such persons
will be able to apply for a determination of disability and will be able
to have their benefit amounts recalculated, excluding the entire period
of their total disability occurring before they reached retirement age.
For beneficiaries who qualify, this recalculation of their benefits will
result in appreciable increases in monthly benefit payments. Benefit
increases resulting from the freeze will be payable beginning with
benefits for the month of July 1955.
If application is filed before July 1, 1957, a disability freeze appli-
cation can establish a period of disability beginning on the earliest
date the individual was disabled and met the earnings requirements
provided in the law. This means that an individual who was totally
disabled as early as October 1941 can establish a period of disability
provided he had acquired sufficient covered earnings credits, was con-
tinuously disabled until he filed his application for a disability freeze,
and filed such application before July 1, 1957. After the grace period
provided in the law has expired (that is, beginning July 1, 1957) a
period of disability can be established no more than one year retroac-
tively from the time application is filed.
Only persons who have been working regularly in jobs covered by
the social security law are eligible for the protection of this provision.
Not only must the worker be under a total disability, as that term is
defined in the law, but he must have had substantial and recent earn-
ings under the program before becoming disabled—to be specific, he
must have acquired covered earnings credits for 5 years out of the 10
years before becoming disabled, and one and one-half years of these
5 years must have occurred during the 3 years before he became dis-
abled.
Only those individuals who have been totally disabled for at least 6
months by illness, injury, or other physical or mental impairment
which can be expected to be of long-continued and indefinite duration
may qualify for the freeze. The impairment must be medically de-
terminable and must prevent the individual from performing any
substantial gainful work. An individual will also be considered to
meet the definition of disability if he is totally blind within the mean-
ing of that term as defined in the law.
Determinations of disability will, for the most part, be made by
State agencies administering vocational rehabilitation programs
or other appropriate State agencies with which the Secretary of
Health, Education, and Welfare may make agreements. The Depart-
ment of Health, Education, and Welfare will develop and promulgate
36 Department of Health, Education, and Welfare, 1954
0 EE ae
standards to be used in determining disability for the purposes of the
freeze. The use of such standards will promote equal treatment of all
disabled persons under the freeze provision regardless of State of
residence. The cost of making disability determinations will be met
out of the Federal old-age and survivors insurance trust fund. In
cases where the individual is not covered by an agreement between
the Department and a State, disability determinations will be made by
the Department. Department determinations will be necessary for
individuals residing outside the United States, or residing in States in
which no agreement has been made, and individuals in certain types
or classes of cases which have been excluded from the agreement at
the State’s request, such as the large number of backlog cases.
The Congress, on the recommendation of the President, placed
great emphasis upon the importance of greater effort in the rehabili-
tation field, enacting a law which lays the foundation for a tremen-
dously expanded rehabilitation program. A byproduct of the old-age
and survivors insurance disability freeze provision will be an increase
in the number of referrals to State vocational rehabilitation agencies,
not only for the purpose of determining the degree of disability, but
also for the vital human purpose of combating disability and thus re-
turning disabled people to a productive status in our economy. The
prompt referral of disabled persons for necessary rehabilitation serv-
ices 1s expected to increase the effectiveness of these services, and
greatly enhance the prospect of successful rehabilitation.
FINANCING THE PROGRAM
In considering the financing arrangements for old-age and survivors
insurance, Congress has recognized that the assets of the trust fund
need not be and should not be maintained at a level required of private
insurance. Congress has, however, made clear its intent that the old-
age and survivors insurance program be self-supporting from contribu-
tions of covered workers and employers. Since under the 1954 amend-
ments future benefit outlays, expressed as a percent of payroll, will be
higher than formerly, the long range schedule of contribution rates set
in 1950 was adjusted to meet the additional costs. The former rate of
314 percent each on employer and employee for years beginning with
1970 was increased to 314 percent each for the years 1970-74 and to
4 percent each in 1975 and thereafter with corresponding increases
for the self-employed. The adjusted contribution schedule was
arrived at after review of long-range actuarial cost estimates of the
new program by the Committee on Ways and Means of the House
of Representatives and the Committee on Finance of the United
States Senate.
Social Security Administration , 37
Congressional committees are fully aware of the difficulties involved
in making exact predictions of the actuarial status and financial opera-
tions of a program that reaches into the distant future. As economic
and other conditions change it is essential that new cost estimates for
the old-age and survivors insurance program be prepared from time to
time in order to take into account the latest operating experience and
other newly available information.
Normally, several different estimates are prepared, combining differ-
ent assumptions as to employment and earnings, mortality and other
demographic factors, and interest rates. No one of the estimates is
considered to be the most probable for the long run. Each represents
a reasonable set of assumptions tending in the direction of either high
costs or low costs. The assumptions used are reviewed by an Actuarial
Advisory Committee from outside of the Government. At present the
members of the Committee are Reinhard A. Hohaus, Vice President
and Chief Actuary, Metropolitan Life Insurance Company; Clarence
A. Kulp, Professor of Insurance, University of Pennsylvania; Kermit
Lang, Assistant Actuary, Equitable Life Insurance Company of Iowa;
and W. R. Williamson, Consulting Actuary.
The result of preparing such a series of estimates is a range of pos-
sible costs rather than a single figure. It is clearly impossible, how-
ever, to base a schedule of contribution rates on a range of possible
costs. In determining the contribution schedules, congressional com-
mittees have adopted the practice of relating the contribution rates to
the “intermediate” cost estimate based on high employment assump-
tions. ‘This “intermediate” estimate is merely the midpoint between
the high and low cost estimates; it is not an attempt to predict the
precise cost of the program and should not be regarded as such.
The level-premium cost of the benefit payments and administrative
expenses of the program, after making allowance for the existing trust
fund and the lower contribution rate for the self-employed as compared
with the combined employer-employee rate, is estimated at 7.50 percent
of payroll (on the “intermediate” basis using an interest rate of 2.4
percent), or about 0.9 percent of payroll higher than the corresponding
cost of the old program. As a result of the upward revision in the
contribution schedule, revenues were increased nearly 1.1 percent on a
level premium basis. Thus the deficiency of 0.6 percent of payroll
indicated by the latest estimates for the old law was reduced by one-
third to 0.4 percent. Itshould be pointed out that changes in a number
of factors—for example, interest rates, mortality rates, or wage
levels—could modify these results. No one set of long-range estimates
should be looked upon as “final.”
38 Department of Health, Education, and Welfare, 1954
Public Assistance
Amendments to the public assistance titles of the Social Security
Act passed by the 83d Congress in 19541 extend two amendments
which would otherwise have expired during the coming fiscal year.
A 1952 amendment raised the maximums on the amounts of indi-
vidual payments in which the Federal Government can participate
and increased the Federal share within these maximums.? Primarily
as a result of this amendment, average monthly payments from June
1952 to June 1954 have been increased by $4.54 for the blind; $4.34
for the aged; $3.17 for the disabled; and $1.45 for mothers and chil-
dren. In most States these increased payments were financed entirely
from the additional Federal funds. This amendment which would
have expired on September 30, 1954, was extended until September
30, 1956. If this more generous matching provision had not been
extended, States would have received about $150 million less in Fed-
eral aid during the remainder of the 1955 fiscal year. As a result,
States would either have had to reduce payments to the needy or raise
more State and local funds to maintain present payments.
Similarly, an amendment passed in 1950 permitted Federal approval
of certain State plans for aid to the blind even though they did not
require consideration of the blind individual’s income and resources
in determining his need, if they met all other requirements for ap-
proval.* However, Federal funds still are available only for cases in
which income and other resources have been considered. This amend-
ment which would have expired on June 30, 1955, was extended for 2
additional years. Approval of the Pennsylvania and Missouri aid
to the blind laws granted under this temporary provision was thereby
extended until June 30, 1957.
Other actions taken by the 83d Congress directly affect the public
assistance program. The 1954 amendments to the Social Security Act
expanding and liberalizing the old-age and survivors insurance pro-
gram will have both long-time and immediate effects on public assist-
ance.
The expansion of the old-age and survivors insurance program to
almost universal coverage is expected to reduce gradually the number
of needy aged who are dependent on old-age assistance. With exten-
sion of coverage to many self-employed farmers, additional farm
workers, and other groups not formerly included, it is estimated that
by about 1980, a very high proportion of the retired aged will receive
old-age and survivors insurance benefits and will need old-age assist-
1 Public Law 761, 83d Congress, approved Sept. 1, 1954.
2 Public Law 590, 82d Congress, approved July 18, 1952.
3 Public Law 734, 8ist Congress, approved Aug. 28, 1950.
39
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40 - Department of Health, Education, and Welfare, 1954
ance only to supplement low benefit payments or to pay for medical
or nursing care or other special needs.
More annette effects are anticipated from the liberals of
the old-age and survivors insurance system. Some 463,000 aged per-
sons now receiving old-age assistance to supplement chain insurance
benefits will get increases of about $5 per month. About 32,000 fami-
lies who are now receiving aid to dependent children payments to
supplement their insurance benefits will also get benefit increases.
Some additional widows and children receiving public assistance will
now receive benefits because of the extension of protection to the
survivors of wage earners who died after 1939 and before September
1950 and who, although they had at least 6 quarters of coverage, were
not insured under the provisions of the 1989 act.
In addition, amendments to the Vocational Rehabilitation Act
which extend and improve vocational rehabilitation services will in-
crease the services available to the disabled, some of whom receive
public assistance. Better care for needy persons who are ill or dis-
abled should also result from the new amendments to the hospital
survey and construction provisions of the Public Health Service Act,°
which make funds available to States for diagnostic or treatment
centers, chronic disease hospitals, rehabilitation facilities, and nursing
homes.
Another action taken by the 83d Congress will enable the Bureau
to begin work on certain responsibilities delegated to the Department
by the Federal Civil Defense Administration. An appropriation of
funds will enable the Bureau to plan a program for cash assistance
to civilians injured or in need because of enemy attack and for clothing
to civilians in need because of attack.®
Caseload and Expenditures’
About 6 percent. more needy persons received assistance in June
1954 than a year earlier. From 5.3 million in June 1953 the total
number, including those receiving general assistance, increased to 5.6
million in June 1954. The old-age assistance program was the only
one which showed a decline. AJl the other four programs showed
an increase in the number of persons receiving aid. Factors con-
tributing to this increase included the normal growth of the relatively
new program of aid to the permanently and totally disabled; the dis-
continuance, early in 1954, of benefits paid by the United Mine
Workers to disabled miners and families of deceased miners, many of
4 Public Law 565, 88d Congress, approved Aug. 3, 1954.
5 Public Law 482, 88d Congress, approved July 12, 1954.
6 Public Law 668, 83d Congress, approved Aug. 26, 1954.
7 Averages and totals include money payments to recipients and vendor payments for
medical care and cases receiving only such payments,
Social Security Administration 41
whom became eligible for public assistance; and an increase in the
number of persons receiving general assistance, probably reflecting
somewhat lower levels of employment in some areas of the country.
The 1.6 percent increase in expenditures for assistance in 1954 over
the preceding 12 months, an increase of $40 million, brought total
Federal, State, and local expenditures for public assistance for the
fiscal year to $2,563 million. Monthly average payments for families
receiving aid to dependent children rose $1.10 and the average per
general assistance case was up $4.46. There was little change from
last year in the average payments for recipients of other types of
assistance for the Nation as a whole. Average payments by State
and by category are given in chart 4.
Although a few States had to reduce payments because of limited
funds, several others raised payments to meet a higher proportion of
need or to reflect price changes that occurred in the preceding year
or earlier. Vendor payments for medical care accounted for a sizable
portion of the increase in a few States with greater than average
change in payments.
At the end of the year fewer than 1 in every 30 in the population
was receiving public assistance. The proportion of the population
receiving assistance, by States, is given inchart 5. The total expendi-
tures of $2,563 million represented 0.9 percent of personal income
payments in the Nation in the calendar year 1953. The Federal share
of this expenditure was $1,321 million.
Old-age assistance.—Ahbout. 26,500 fewer persons received old-age
assistance in June 1954 than in June 1953. The 2,582,000 persons
receiving assistance represented a decrease of 1 percent from the
number in June a year earlier and 227,000 fewer than the number
aided in the peak month of September 1950. In June 1954, for the
Nation as a whole, 184 out of every 1,000 persons aged 65 and over
received old-age assistance, the lowest proportion since before World
War IL.
The national trend downward, starting in October 1950, continued
for most States during the year. More than half the States had fewer
aged recipients in every month of the year. In some of the States
with larger-than-average decreases in caseloads, stricter policies re-
garding relatives’ responsibility were the primary factor in the de-
clines. The largest percentage decrease for any State, however, oc-
curred in Montana where a new lien law gave the State a claim against
the estates of recipients of old-age assistance. The national average
monthly old-age assistance payment in June 1954 was $51.45 as com-
pared with $51.08 in June 1953.
Aid to dependent children—About 17,600, or 3 percent, more fami-
lies were receiving aid to dependent children in June 1954 than in
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Social Security Administration 43
the preceding June. Nearly three-fourths of the States were aiding
more families in June 1954 than a year earlier, including 12 States in
which the number of families represented an increase of more than
10 percent, with one State showing nearly 30-percent increase. On
the other hand, 13 States were aiding fewer families than in the pre-
vious year; relatively large decreases occurred in 5 jurisdictions. The
average monthly payment per family in June 1954’ was $85.08 (or
$23.81 per person) as compared with $83.98 per family (or $23.89
per person) in June 1953.
Aid to the permanently and totally disabled.—F orty-two States, as
compared with 39 a year earlier, are now administering programs
with Federal financial participation provided under a 1950 amend-
ment to the Social Security Act. Connecticut, Minnesota, and Ten-
nessee, which established programs during the year, contributed to
the 18-percent increase in the number of recipients. The total number
of recipients in the 42 States was 211,700 in June 1954, as compared
with 179,400 in 39 States in 1953. The average monthly payment was
$53.51 as against $53.72 in June 1953.
Aid to the blind—About 2,000 recipients were added during the
year to the aid to the blind program, bringing the total to about 101,000
in June 1954. All jurisdictions are administering aid to the blind
with Federal financial participation. The average monthly payment
in June 1954 was $55.80 as compared with $55.53 in June 1953.
General assistance—The 299,000 cases on the rolls in June 1954
represented an increase of 16.5 percent from the preceding June.
Caseloads increased in two-thirds of the 48 jurisdictions for which
data are available; in about half the States they rose by 10 percent or
more, including 11 States where the increases exceeded 30 percent.
Fewer cases were reported in 16 States with the largest decrease due
to continued transfer of cases to the program of aid to the permanently
and totally disabled. General assistance, financed entirely from State
and/or local funds, is affected by lower employment levels to a greater
extent than the federally aided assistance programs, since it includes
a larger proportion of persons who are actually or potentially em-
ployable. The national monthly average per case was $51.62 in June
1954 as compared with $47.16 a year earlier.
Effect of Old-Age and Survivors
Insurance on Public Assistance
As indicated in chart 6, the increase in the number of aged persons
receiving old-age and survivors insurance benefits during the past few
years has been accompanied by a decline in the number of aged persons
dependent on public assistance. In 1954 almost twice as many aged
44. Department of Health, Education, and Welfare, 1954
persons received insurance benefits as received public assistance, where-
as, as recently as 1950 more aged received assistance than benefits.
Between 1950 and 1954 there was also a 50-percent increase in the
number of paternal orphans receiving benefits, and a decline in the
number of such children receiving assistance.
Aged persons receiving both insurance and assistance—In February
1954 about 460,000 or 10 percent of the aged insurance beneficiaries
received old-age assistance to supplement their insurance benefits.
They represented 18 percent of the old-age assistance caseload for that
month.
Insurance beneficiaries who receive minimum or near minimum
benefits and who have few other resources, and those with special
needs, often require additional financial help. Before September
1954, the minimum insurance benefit paid to a retired worker was
$25 per month, and minimums for aged wives and widows of insured
workers were $12.50 and $18.80, respectively. Early in 1953 about
40 percent of those receiving both insurance and assistance received
benefits of $25 a month or less; half received less than $30. The 14
percent who received old-age assistance to supplement benefits which
exceeded $50 per month undoubtedly included many persons who
needed assistance to help meet costs of medical care or other unusual
expenses.
The number of aged persons getting both assistance payments and
insurance benefits increased sharply immediately after amendments to
the Social Security Act in 1950. Because benefits paid to newly eli-
gible persons were generally low, many old-age assistance recipients
receiving benefits for the first time continued to need assistance.
Since then, the number of persons getting both types of payment has
continued to rise but at a more gradual rate. The net increase in the
number of aged persons receiving both types of payment from Septem-
ber 1950 to August 1951 was 100,000, and only 187,000 from September
1950 to February 1954.
The proportion of assistance recipients with benefits has risen from
nearly 10 percent in September 1950 to 18 percent in February 1954.
As the older old-age assistance recipients come off the rolls, usually
because of death, and as the new old-age assistance cases are more likely
to be eligible for insurance, the proportion of assistance cases receiving
both types of payments is expected to increase further. On the other
hand, with increasing numbers of persons becoming eligible for insur-
ance benefits, the proportion of insurance beneficiaries receiving assist-
ance has decreased from 13 percent in 1950 to 10 percent in 1954.
The broader coverage of the old-age and survivors insurance pro-
gram will have little effect on the present caseload in old-age assistance
which consists mostly of individuals who never had an opportunity to
Social Security Administration 45
Chart 6.—GROWTH IN SOCIAL INSURANCE PROTECTION FOR THE AGED?
NUMBER PER 1,000 AGED
500
400
300
200
100
|
OAS! (AGED)
0 :
1940 ‘41 ‘42 ‘43 '44 ‘45 ‘46 ‘47 ‘48 ‘49 'SO0 ‘S| ‘52 ‘83 ‘54
1 Average monthly number of beneficiaries and recipients, by years, per 1,000 persons aged 65 and
over in the population.
obtain coverage under the insurance program. Half the recipients are
aged 75 or over, and some were already out of the labor market before
the Social Security Act was passed. There are also the needy aged who
worked in employments not covered, or only recently covered, by the
insurance program, and wives and widows of uninsured workers.
About three-fifths of the recipients of old-age assistance are women,
most of whom have had no recent employment, if any at all.
Average assistance payments to individuals receiving both insurance
and assistance are lower than assistance payments to recipients who do
not receive benefits. The average monthly old-age assistance payment
for recipients not getting insurance benefits was $53.94 in February
1954; the average monthly amount of assistance for recipients getting
both insurance benefits and assistance payments was $43. The average
insurance benefit received by aged persons getting both assistance and
benefits was $33.91 in February 1954.
46 Department of Health, Education, and Welfare, 1954
he attest Mevacor oe
Families with children recewing both insurance and assistance.—
Since the insurance program provides benefits primarily to those
children whose insured parent has died, its effect on the size of the
aid to dependent children program is limited. Death of the father
was the cause of dependency for only one-sixth of the families receiv-
ing aid to dependent children in November 1953, but incapacity of
the father accounted for more than one-fifth, and absence of the
father for more than one-half.
About 32,000 families received payments under both programs in
November 1953. In 28,000 of these families the father was dead.
In the other 9,000 families an aged, retired parent was the insurance
beneficiary, or the children’s benefits were based on the wage record
of a natural father who died, and their eligibility for assistance on
the more recent absence or incapacity of a stepparent.
The proportion of assistance families also receiving survivors’
benefits has risen only shghtly from less than 5 percent in September
1950 to about 6 percent in November 1953. On the other hand, as
the number of families with benefits has increased, the proportion
receiving both insurance benefits and assistance payee has declined
from 8 percent in September 1950 to 5 percent in November 1953.
Savings in the program for aid to dependent children have also
resulted, since relatively less assistance goes to families receiving
insurance benefits than to other families. In November 1953 the
average assistance payment to families not receiving insurance bene-
fits was $90.07; for families receiving insurance benefits and assist-
ance payments the average assistance payment was $71.35. The
average insurance benefit received in November 1953 by families
getting both aid to dependent children and a benefit under the insur-
ance program was $59.02.
Program Developments
Increasing attention is being focused by the Bureau, the States,
and other interested groups on the coordination of welfare, medical,
vocational, and other services with financial assistance to help needy
persons become self-sufficient to the fullest extent of their capacities.
Since characteristics of persons receiving public assistance show a
close correlation between financial need and neglected health and
personal problems, questions are being raised about the extent of
individual and family breakdown which might have been prevented
if necessary and appropriate help had been available to them at
§ The appropriateness of welfare services in the administration of public assistance was
indicated in a report of the House Ways and Means Committee (Report on H. R. 6000,
p. 55, 1949) which stated, “there is ample authorization for Federal sharing in the costs
of welfare services to applicants for and recipients of State-Federal assistance.”
Social Security Administration 47
the time of crisis. Interest and attention is being directed to learning
how needy persons can be helped to achieve a greater degree of self-
sufficiency, and to determine the nature of services needed to achieve
this goal. |
The Bureau has also been working with other bureaus in the De-
partment and national private agencies in planning for the develop-
ment and utilization of other needed resources in an effort to bring
to public assistance recipients the services now available through
other programs.
SERVICES TO AID TO DEPENDENT CHILDREN FAMILIES
The aid to dependent children program was established to provide
aid to needy children who live with a relative and who are deprived of
parental support or care because of the death, incapacity, or absence
ofaparent. For 16 States studied in 1942, death of the father was the
most frequent cause of dependency, accounting for 37 percent of the
aid to dependent children caseload, and absence of a father from the
home accounted for 36 percent.
By 1948, death as a cause of dependency had declined in relative im-
portance. Absence of a father accounted for need in 46 percent of the
Chart 7.—NUMBER OF CHILDREN RECEIVING AID TO DEPENDENT CHILDREN WITH FATHER
DEAD,” AND NUMBER OF SURVIVOR CHILDREN RECEIVING OLD-AGE AND SURVIVORS
INSURANCE, 1950-1954
MILLIONS OF CHILDREN
1.2
SURVIVOR CHILDREN
RECEIVING OASI
ADC CHILDREN
WITH FATHER DEAD 1/
Saf 20m BNE © 20> ©
fe)
1940 ‘41 ‘42 '43 ‘44 '45 ‘46 '47 ‘48 ‘49 ‘50 'SI ‘52 '53 '54
1 Data available only for October 1942, June 1948, and November 1953.
48 Department of Health, Education, and Welfare, 1954
Ch aT tliat a Manette
families receiving aid to dependent children in the United States, and
rose to 54 percent in November 1953. This shift was due partly to the
expansion of the old-age and survivors insurance program in provid-
ing income to children of insured workers who die. With the avail-
ability of insurance benefits to surviving children, the proportion of
families receiving aid to dependent children where need was due to the
death of the father declined from 37 percent for 16 States in 1942 to
17 percent in the country as a whole in 1953. Chart 7 shows the de-
cline in the actual number of paternal orphans receiving assistance
from 1940 to 1954 in contrast with the rise in the number of survivor
children receiving insurance benefits.
The increasing size of the group of children needy because of the
absence of the father has focused public attention on the problems of
broken families, especially those involving desertion and abandon-
ment. The size and complexity of the problem of deserting parents
is also of major concern to Federal and State public assistance agen-
cies. Various proposals have been made for coping with these prob-
lems. For example, recognizing that the legal responsibility of a
parent for the support of his minor children is clearly established in
the laws of every State, Congress amended the Social Security Act in
1950 to require that, effective July 1, 1952, State public assistance
agencies give prompt notice to appropriate law-enforcement officials
when assistance is furnished to children who have been deserted or
abandoned by a parent.
Notification was given in about one-fourth of the cases receiving
aid to dependent children in June 1952. Law-enforcement officials
were notified of the desertion or abandonment of about 368,000 chil-
dren in 155,000 families. In about 5,100 cases involving approxi-
mately 9,000 children (fewer than 1 percent of the caseload in June
1952), the relative caring for the children preferred to have assistance
discontinued or reduced to having enforcement officials notified.
The whereabouts of about half of the absent parents brought to the
attention of law-enforcement officials was unknown. The where-
abouts of an additional 18 percent of the absent parents, though
known, was outside the State. About 40 percent of the absent parents
had been away for 5 or more years, 45 percent had been gone from 1 to
) years, and 12 percent less than a year.
The increasing interest and concern about the social problems of
aid to dependent children families has also sharply pointed up the
need for planning additional ways of helping families to deal with
their problems in a constructive way. Social agencies have long
been working with individuals who have problems resulting from de-
sertion and illegitimacy. Never before, however, have these prob-
lems been as concentrated in one program as now in the aid to de-
Social Security Administration 49
pendent children program. This concentration has led to concerted
effort by Federal, State, and local public welfare agencies in planning
to meet other needs of aid to dependent children families in addition to
financial assistance.
Public Assistance-Children’s Bureau working group on services.—
A working group composed of staff from both the Children’s Bureau
and the Bureau of Public Assistance has developed a draft statement
concerning the cooperative activities that could be utilized in the
development of services for aid to dependent children families. Dur-
ing the year, this committee has been considering basic concepts of
service in the aid to dependent children program, the potentialities
of the child welfare and aid to dependent children programs in provid-
ing needed services, goals toward which work could be directed, and
the nature of program and administrative planning required to achieve
these goals.
The committee recognized that, while many families receiving aid
to dependent children are able to handle their own problems, many
other families have problems which require more specialized types of
service than are now available to them. It was recognized that States
need staff equipped to offer such services. ‘Therefore, the social serv-
ice needs of aid to dependent’ children families were identified to ~
provide perspective to States in determining how much they are able
to do, and to plan their direction in relation to staffing, training, pro-
gram planning, and policy formulation. The committee’s draft state-
ment is being used for discussion and evaluation of the subject by both
child welfare and public assistance agencies throughout the country.
State developments in services.—Other activities of both State
agencies and Bureau staff have also been related to services. A con-
ference on services in the aid to dependent children program was
held in Shreveport, La., in March 1954. Public assistance and child
welfare staff from Arkansas, Louisiana, New Mexico, Oklahoma, and
Texas participated in the discussions. Services needed and those
provided in a group of aid to dependent children cases were analyzed.
Out of the discussion, minimum services needed in all aid to dependent
children cases and in special problem cases were identified. Some of
the principles developed by the working group of the Children’s
Bureau and Public Assistance on services needed in aid to dependent
children families were tested out in this conference. Recommenda-
tions made dealt with ways of achieving increased social benefits
through the aid to dependent children program.
One State conducted a workshop for its field staff on methods of
helping parents and children use their own resources to achieve maxi-
mum independence. A report on this workshop was issued by the
State agency. Another State made an intensive study of its caseload
50 Department of Health, Education, and Welfare, 1954
to determine the extent, sources, and nature of criticisms and com-
plaints made about its aid to dependent children program in recent
years.
A project on services has been conducted by one State with special
funds appropriated by the State legislature in an effort to further
protect children from the effects of family breakdown. Help has been
given in many types of family difficulties through use of available
community resources and by providing counseling in a variety of
areas including education, housing, nutrition, home management, con-
sumer education, social adjustment, and parent and child adjustment.
Effort was made to identify special services which might prevent
further deterioration in family relationships and to bring appropriate
community resources into play at an early stage. Other work done
included planning with adolescents for vocational training and em-
ployment and helping parents and children with health problems.
Problems remaining when assistance was terminated were also identi-
fied, and in some instances work with the family was continued for a
period of time. While increasing use was made of existing facilities,
the dearth of community resources for diagnosis and treatment of
various kinds of health and emotional problems and for vocational
rehabilitation was markedly evident.’ It was found that the needs
of many aid to dependent children families cannot be met without
the development of additional community resources.
EMPHASIS ON REHABILITATION AND SELF-CARE
During the last few years there has been a marked increase in both
Federal and State interest in the provision of services aimed at
rehabilitation and self-care. Examples include study of the kinds
of services needed, organizational changes and caseload adjustments
to emphasize services, demonstration projects, and re-focus in staff
development and policy development to clarify the services to be given.
Experiments conducted by several States in selected localities have
shown the social benefits and the potentials for savings in public
assistance expenditures when services are provided. States are in-
creasingly requesting help and looking to the Bureau for leadership
in developing these services, in determining the qualifications of
workers needed to provide them, and in the training of staff.
It is believed that some recipients of public assistance who, because
of age or disability require considerable care from others, could be
helped to learn how to care for themselves and thus release the time
of others in the family for more productive pursuits. Some of the
120,000 who live in institutions might also be helped to live in a setting
outside an institution. Institutional care as well as the cost of care
of aged persons in their own homes is costly. Any improvement in
Social Security Administration aly % Mi) ks 51
a person’s ability to care for himself would be beneficial not only
in terms of cost, but to the individual himself.
Others receiving public assistance, with the help of vocational re-
habilitation and other services, might be helped to return to employ-
ment. For example, 20 percent of the recipients of old-age assistance
are under 70 years of age, and 82 percent of all aged recipients are
physically able to care for themselves. In fiscal year 1953, 15,000
recipients of old-age assistance returned to employment and had
public assistance discontinued. Employment or increased earnings
of a member in the family also accounted for 35 percent of the aid
to dependent children cases closed during the past year. Nearly
6 percent of blind recipients earn some income. Even among re-
cipients of aid to the permanently and totally disabled, rehabilitation
has enabled some to return to employment. The aged, the blind, and
those receiving aid to the permanently and totally disabled constituted
21 percent of the more than 11,300 assistance recipients rehabilitated
in fiscal year 1953 by State vocational rehabilitation agencies.
Coordination of public assistance and vocational rehabilitation
programs.—Nearly 20 percent of new referrals to State vocational
rehabilitation agencies came from State public assistance agencies,
and slightly less than 20 percent of the persons rehabilitated by voca-
tional rehabilitation agencies in fiscal year 1953 received some public
assistance before or during their rehabilitation. Amendments to the
Vocational Rehabilitation Act passed in 1954 make possible even
closer coordination of the services available under both public assist-
ance and vocational rehabilitation programs.
In the enactment of the amendment to the Social Security Act in
1950 introducing the aid to the permanently and totally disabled
program, the intent of Congress was made clear that State public
assistance agencies should work closely with vocational rehabilitation
agencies in making the opportunity available to those for whom voca-
tional rehabilitation appeared possible. Since then, the Bureau of
Public Assistance and the Office of Vocational Rehabilitation have
been reviewing their policies and practices in order to increase the
effectiveness of their cooperative efforts. State agencies administer-
ing aid to the permanently and totally disabled have been required
in their State plan to include a description of their working agree-
ments with vocational rehabilitation agencies. The 1954 amend-
ments to the Vocational Rehabilitation Act now also require a State
vocational rehabilitation plan to provide for cooperation with, and
the utilization of, the services of the State agency administering
public assistance.®
® Public Law 565, sec. 5 (a), (9), 88d Congress, approved Aug. 3, 1954.
52 | Department of Health, Education, and Welfare, 1954
During the past year, representatives of both the Office of Voca-
tional Rehabilitation and the Bureau of Public Assistance have been
considering ways in which they can help State and local agencies to
provide better rehabilitation services to public assistance recipients.
The importance of early identification and referral of public assist-
ance recipients who could probably benefit from rehabilitation serv-
ices 1s being stressed.
Increasing use of State review team.—In States presently admin-
istering the aid to the permanently and totally disabled program,
determinations of the eligibility factor of permanent and total dis-
ability are in most cases made by a State review team. In addition
to the physician and social work members of the team representing
the State public assistance agency, a representative of the State voca-
tional rehabilitation agency is often a regular team member. States
have found this joint activity has many values. The opportunity
afforded the applicant of having his total situation studied and under-
stood, and appropriate suggestions made for helping him, is also
enhanced.
Within the past few years, new ways have been tried to serve dis-
abled people in all the assistance programs. In some States, a State
review team has been used in an appraisal of the incapacity of parents
in the aid to dependent children program. In other States, teams,
similar to the State review team, have been set up in some local com-
munities. They are usually called “evaluation teams” or “clinic teams”
and are made up of medical representatives, vocational rehabilitation
and employment counselors, and social workers. The individual being
evaluated is interviewed by each team member. A number of seri-
ously disabled people after a thorough current appraisal have been
found to be far from hopeless as far as rehabilitation is concerned.
Other activities relating to services —Staft of the Children’s Bureau
and the Bureaus of Public Assistance and Old-Age and Survivors
Insurance are Jointly considering the need for services of both children
and retired workers receiving insurance benefits, and evaluating the
resources available to them. A Bureau of Public Assistance staff
member also serves on an American Public Welfare Association com-
mittee on the aging. This committee is studying services needed by
all old-age and survivors insurance beneficiaries and the role of public
welfare in providing them. Bureau staff likewise worked with the
National Social Welfare Assembly’s Conference on Individualized
Services, encouraging the development of individualized services in
small communities and rural areas, and strengthening the working
relationships between public and private social welfare agencies. Rep-
resentation has also continued on the national Committee on Home-
maker Services which is studying and evaluating the effectiveness of
homemaker services. The value of homemaker service where needed
Social Security Administration . 53
for families receiving public assistance is also being studied by the
Bureau.
Exploratory work also has been done toward strengthening services
through greater use of citizen participation. Volunteers can serve a
real purpose in the field of public assistance through rendering serv-
ices that would include personal interest in public assistance recipi-
ents; interpretation of the purpose and function of public assistance
to lay groups; and promotion of a closer understanding between vol-
untary and public welfare agencies and other organizations concerned
with services to people. An experienced volunteer has been working
on this aspect of the program.
STANDARDS OF INSTITUTIONAL CARE FOR THE AGED, BLIND, AND
DISABLED
The nationwide movement to raise standards of institutional care,
considerably advanced by a Social Security Act amendment passed
m 1950 and effective July 1, 1953, continued with increasing vigor
during the past year.
The standard-setting amendment, intended to assure adequate stand-
ards of care and protection against hazards threatening the health
and safety of residents of institutions, requires a State to designate
an authority to establish and maintain standards for institutions in
which individuals may live and be eligible for federally aided assist-
ance. Under this amendment, each State is responsible for adopting
safety and sanitation regulations and for setting standards of care
at levels that seem practical and realistic in that State. Most States
already had authorities that set standards for hospitals and institu-
tions caring for children, but comparable protection had not been
given generally to adults. Substandard institutions for aged and
infirm adults still exist in many parts of the country and many public
assistance recipients, because of their limited economic circumstances,
are living in these institutions. |
The amendment has already achieved in large measure the congres-
sional intent of State assumption of responsibility for standards in
institutions in which persons eligible to receive public assistance pay-
ments may live. All hospitals are now covered under a standard-set-
ting authority in almost all the States and Territories, and there is
marked increase in coverage in domiciliary care and commercial homes.
However, in some States there are still certain types of institutions
not yet covered by the State’s standard-setting authority. Federal
financial participation is not available for assistance payments to
needy persons in these institutions. In general, however, States are
assuming increasing responsibility for a more adequate quality of in-
stitutional care. With most legislative activity required under the
54 Department of Health, Education, and Welfare, 1954
standard-setting amendment completed, States are now moving on to
the consideration of other areas of standard setting.
There has been continuing cooperative activity with national organi-
zations, both public and private, concerned with institutional care.
The many voluntary and public welfare agencies which worked coop-
eratively in developing plans for carrying out this amendment have
continued to lend their aid and support in its implementation. Rep-
resentatives of some of the organizations included on the National
Advisory Committee which initially helped the Bureau define and
interpret its responsibilities under this amendment have continued
to serve on similar advisory committees of State and local agencies
administering the program and on national committees concerned
with this area. The Public Health Service has also continued its coop-
eration in coordinating the activities of public health and public —
assistance agencies in relation to standard setting for institutions. _
Bureau representation has continued on the National Social Wel-
fare Assembly’s committee on standards of care for older people in in-
stitutions, and in the planning and sponsoring of three regional con-
ferences on this subject during the year. These conferences, held in
Washington, D. C., New Orleans, and St. Louis, brought together
representatives of standard-setting authorities and health and wel-
fare agencies active in this field; and administrators of nursing homes,
homes for the aged, and other institutions. The purpose of these con-
ferences was to advance the quality of institutional care by bringing
together people with major responsibility and interest in this area
under circumstances which would permit interchange of experience
and viewpoints and consideration of common problems. Discussion
brought out the need for further consideration by public assistance
agencies of the adequacy of the rates being paid for care of public —
assistance recipients in institutions, and the availability of public
medical services for this group. It also pointed to the need for fur-
ther participation of public assistance agencies in community plan-
ning for institutional care, since public assistance recipients constitute
a high proportion of those receiving institutional care in many com-
munities. Although there was evidence of considerable variation in
the quality of care given, the intensity of interest and ingenuity of
effort being expended in many parts of the country in an attempt to
improve standards of institutional care is heartening.
The National Social Welfare Assembly published a comprehensive
report of these conferences. Since considerable content of the dis-
cussions was related to the role of public assistance agencies, a sum-
mary of the report was prepared by the Bureau for State agency use.
The viewpoints expressed at these conferences concerning public
assistance programs and practices warrant consideration and further
evaluation by public welfare agencies.
Social Security Administration 55
PUBLIC INSPECTION OF PUBLIC ASSISTANCE ROLLS
There are now 29 States with legislation permitting public inspec-
tion of disbursement records of persons receiving federally aided pub-
lic assistance. A provision of the Revenue Act of 1951 made it pos-
sible for States to enact legislation to make available to the public the
names, addresses, and amounts of assistance received by individuals,
without loss of Federal funds.
Two States, Ohio and Pennsylvania, passed legislation in fiscal
year 1954 providing for public access to public assistance disbursement
information; 20 States had passed such legislation in the previous
year.
States that have studied the effect of such legislation found that
only a very limited number of requests were made to inspect the
assistance rolls. Also, after the first few months following passage
of their legislation, public interest appreciably lessened. In general,
the provision making it possible for the public to inspect the lists of
those receiving assistance appears to have had little effect on either
caseloads or expenditures under the public assistance programs.
Most of the studies made by interested individuals and groups on the
effect of this legislation have reached similar conclusions.
Administrative Operations
Mr. Jay L. Roney assumed the responsibilities of the Bureau Di-
rector on March 29, 1954, replacing Miss Jane M. Hoey. Mr. Roney
was formerly Director of Public Welfare in South Dakota, and more
recently was a member of the field staff of the Children’s Bureau.
The closing of the Department’s Cleveland regional office resulted
in replanning of the Bureau’s regional staff and workload in the three
realined regions. Budget limitations for the ensuing year also re-
sulted in additional replanning at the end of fiscal year 1954 of staff
and workload both in the regional and central office of the Bureau.
Mr. Roney, Bureau Director, was appointed new Chairman of the
Interdepartmental Committee on International Social Welfare Policy.
The committee met several times during the year to consider social
welfare items on the agenda of the United Nations Economic and
Social Council, and to prepare for the inter-American conferences.
The Bureau continued to provide technical services to trainees and
visitors from other countries, arranging study and observation pro-
grams for trainees and briefer consultations for short-term visitors.
The Bureau also recommended experts for overseas missions and
provided technical information to social welfare consultants serving
as United States consultants in other countries. In addition, the
Bureau cooperated in providing data for several international studies
in social welfare conducted by the United Nations.
56 Department of Health, Education, and Welfare, 1954
During the year the Bureau continued its review, analysis, and
evaluation of many aspects of the State and local public assistance
programs, as well as its study of characteristics of certain groups of
recipients. Technical help was also provided to States upon request
in many areas of public assistance administration.
REVIEW OF STATE AND LOCAL OPERATIONS
During fiscal year 1954, administrative reviews of State and local
administration of public assistance were conducted in 25 States.
A total of 10,536 case records was analyzed and administrative proc-
esses were studied in 29 local agencies in 9 States.
The nature of the review varied both in scope and method. In 11
States statistically selected Statewide samples of case records were
reviewed to determine the eligibility of persons receiving assistance
and the accuracy of payments made to them. In six jurisdictions the
case review was supplemented by administrative analyses in selected
local agencies. Subject areas examined were eligibility and payment,
application process, various aspects of the aid to the permanently and
totally disabled program, appeal hearings, State supervision, and local
administration. ‘To a more limited extent, the operations of special
investigating units were studied in six States. In addition, test checks
were made in three States to determine the validity of data procured
by the States in their own review process.
STUDIES AND PUBLICATIONS
Financial support of parents by adult children.—In cooperation
with the States a study was made of the general support laws and
State old-age assistance plan provisions on responsibility of adult
children for support of their aged parents. A report summarizing
the findings of the study was published in two articles in the Social
Security Bulletin for April and May 1954. These are entitled “Old-
_ Age Assistance: Plan Provisions on Children’s Responsibility for
Parents,” and “Old-Age Assistance: Determining Extent of Children’s
Ability to Support.” A summary tabulation of pertinent plan pro-
visions in each State was also prepared.
Characteristics of recipients of aid to the permanently and totally
disabled.—T wo articles analyzing selected characteristics of recipients
of aid to the permanently and totally disabled revealed through the
nationwide study conducted in 1951, were published in the October and
November 1953 issues of the Social Security Bulletin. These were
entitled “Aid to the Permanently and Totally Disabled: The Young
Recipients” and “Aid to the Permanently and Totally Disabled:
Characteristics of Men and Women Recipients.”
Some of the significant findings of this study follow:
Social Security Administration 57
Diseases of the heart were found more frequently than any other group of
diseases or impairments. One-fourth of the recipients of aid to the permanently
and totally disabled had a disease of the heart as the sole or major impairment
resulting in permanent and total disability.
The young disabled persons, those under age 35, were the most seriously handi-
capped of all recipients of aid to the permanently and totally disabled. Many
suffered from mental deficiency and other disabilities of congenital or birth
origin. Relatively more of them than of the older recipients were confined to
their homes and required services from oLher persons in daily activities, and their
disabilities were also of longer duration.
The numbers of men and women receiving aid to the permanently and totally
disabled were about equal, although the men appear to have been more severely
disabled than the women.
Characteristics of recipients of old-age assistance.—W ork is near-
ing completion on the study of the requirements, income, resources,
and social characteristics of recipients of old-age assistance initiated
in 1958. Preliminary information obtained from this study has al-
ready been made available for specific uses by public and private
groups. Release of tabular data and highlights of the findings is
planned for early 1955.
Preliminary data include the following findings of interest:
Four-fifths of all needy aged receiving public assistance are 70 years of age
or older, a fourth are 80 or older, and more than a thousand are over 100 years
old. In spite of the extreme age of many of these needy persons, 82 percent are
physically able to care for themselves and less than 4 percent are bedridden.
The remainder require considerable care from others. Most (69 percent) are
widows, widowers, or single persons, and 60 percent are women. Although the
majority of all aged persons live in large cities, more of the old-age assistance
recipients live in small communities. Almost 60 percent live away from metro-
politan centers, chiefly in towns of 2,500 or less, on farms, or other rural places.
Most of the needy aged men and women live with some relative (59 percent) ;
over a fourth live alone; and less than 5 percent live in any type of institution
or nursing home. Others live with friends, or in hotels or boarding homes.
More than half (54 percent) have been dependent on public assistance for less
than 5 years, and only 5 percent have received it for 15 or more years.
Social information for determining permanent and total disabil-
ity.—In October 1953, Social Information Report was issued as Public
Assistance Report No. 24, for use by State and local agencies in de-
termining eligibility with respect to permanent and total disability.
This report gives a detailed description of the material local workers
can report that will help the State agency decide whether a person is
eligible for aid to the disabled and to recommend appropriate services
to help the person become more self-sufficient and, if possible, self-
supporting. A similar guide on what information is needed from
local doctors was issued about a year ago. States have also found this
publication useful to local staff in understanding and working with
incapacitated parents in the aid to dependent children program and
in other cases where illness is a factor in dependency.
339010—55——5
538 Department of Health, Education, and Welfare, 1954
Public assistance charts.—In collaboration with staff of the Depart-
mental Council, work was also done in planning and providing basic
data for a series of wall charts on public assistance, prepared as part
of a Department-wide chart project for presenting information on
the programs. The charts with accompanying text were reproduced
ina booklet, Public Assistance, Graphic Presentation of Selected Data,
for administrative use and distribution to State public assistance
agencies.
TECHNICAL ASSISTANCE TO STATES
State agencies have been generally interested in improving their
administration to operate at a maximum of efficiency, and in provid-
ing services that will help dependent persons achieve self-maintenance ~
wherever possible as well as strengthen family relationships. To this
end, technical assistance has been provided by the Bureau to State
agencies upon request in the development of specific program areas,
in management improvement, and in staff development.
Development of specific program areas —Consultation services have
been made available on various aspects of program development.
State agencies have requested technical assistance especially in the
development of welfare services, and in the improvement of the med-
ical aspects of their programs, including the determination of per-
manent and total disability in the aid to the permanently and totally
disabled program, and the incapacity factor in the aid to dependent
children program. States have also requested consultation on other
aspects of the eligibility process, including clarification and improve-
ment in their standards and policies governing the determination of
need and the determination of blindness and in development of appro-
priate services in the aid to the blind program.
Management improvement.—Technical assistance and consultation
have also been provided in many areas to insure proper and efficient
administration of public assistance programs. Several States have
been helped in the review of their administrative and fiscal procedures
and controls. Technical assistance on State and local organization has
been given States resulting in a realinement of functions in many
instances. Consultation was given on workload management; size of
visitor caseload; program financing and administrative budgeting;
use of machine equipment; and requisitioning, payment, inventory,
and accounting procedures. Administrative and fiscal principles and
techniques also have been developed for the use of State agencies.
These have included principles governing Federal financial participa-
tion in costs of assistance and administration; and recommended
standards on the simplification of agency manuals of instructions,
development of State policies and procedures relate to improper
payments, and local agency management.
Social Security Administration 59
As part of their management improvement efforts, States are in-
creasingly interested in using various devices for measuring and
evaluating the job they are now domg. Asa basis for advising State
agencies with respect to a systematic approach to this problem, the
Bureau is working on a methodology for testing and controlling the
quantity and quality of that part of public assistance administration
included in the visitor’s job. One State is now testing this overall
methodology and is working specifically on defining the duties and
scope of work of the public assistance visitor, the quality of perform-
ance expected, and tests that can be used in evaluating performance
relating to determination of initial eligibility.
RECRUITMENT, SELECTION, AND TRAINING OF PUBLIC ASSISTANCE
PERSONNEL
Since the maintenance of efficient administration and a high quality
of welfare services is dependent largely upon the skill of agency staff,
Federal and State agency efforts have been directed increasingly to-
ward meeting the problems facing State agencies in adequately stafling
their programs. Emphasis has been placed on improvement of the
recruitment process, selection methods, and staff training programs.
The shortage of professionally qualified staff continues to be a prob-
lem for all public assistance agencies. Less than 5 percent of the
public assistance workers have professional social work training,
although about 20 percent have had some work in a graduate school
of social work. Although 75 percent of the workers have not had
any professional social work training, two-thirds of them are college
eraduates and thus potentially eligible for professional training. In
an effort to improve the qualifications of public assistance workers,
52 State public assistance agencies have established plans for educa-
tional leave within present provisions for Federal matching of State
administrative costs. However, because of limitations on amount
and/or use of funds in some States, more than half the State agencies
with educational leave plans provide no financial help to workers in
obtaining graduate education. The advisory committee to the Chil-
dren’s Bureau and the Bureau of Public Assistance, meeting in its
19th year, recommended that the Bureau give further attention to
financing professional educational programs and seek legislative au-
thority to provide Federal grants for graduate social work training.
The high rate of staff turnover continues to be of concern to many
State agencies. Although in the Nation as a whole the turnover rate
has lessened, about one-fifth of the public assistance executive and
social work staff left public assistance agencies during this year.
A slightly higher proportion was hired during the year. Staff turn-
over was more concentrated in some areas; for instance in two large
60 Department of Health, Education, and Welfare, 1954
States the number of personnel leaving the agency was as high as a
fourth of the total positions. |
In attempting to meet the problems of shortage of qualified staff
and the high rate of staff turnover in the State public assistance pro-
grams, State agencies have directed their attention to improvement
of recruitment programs. The Bureau has also cooperated with the
Council on Social Work Education which has given nationwide leader-
ship to the development of an intensive recruitment campaign to
attract young men and women to social work as a career. In addi-
tion, the Council on Social Work Education, with a grant from the
Field Foundation, collaborated with the Children’s Bureau and the
Bureau of Public Assistance in sponsoring a workshop for Federal -
and State public welfare staff members who carry some responsibility
for selection of staff for social work positions and for educational
leave. The facilities of the New York School of Social Work were
used in the workshop held in August 1954.
The need for orientation and continued training for staff who are
coming into the agencies or changing positions in the agencies is high-
lighted by the fact that more than 8,000 persons (23 percent of the
total social work staff) were new to their agencies within the year.
In addition, an undetermined number were new to their jobs because
of transfers or promotions.
The Bureau has continued work in the development of appropriate
content, methods, and techniques as a means of being of assistance to
State agencies in the improvement of their staff training programs.
Help has been given to State agencies through consultative services on
the development of comprehensive staff development programs, im-
provement of orientation programs, including the establishment of
training centers for beginning workers; improvement of supervisor-
trainee programs; and the development of handbooks or manuals
for supervision and other aspects of staff development.
The large number of new staff coming into the agencies places
heavy responsibility on supervisory positions for helping this staff
learn their jobs and develop skills in carrying out the agency program.
Several State agencies are doing special work in strengthening super-
vision. One agency has, over a period of several years, worked in-
tensively on the improvement of the supervisee-trainee programs.
Plans are underway for cooperative work with this State agency in
the development of a training document to be issued by the Bureau
for the use of all State agencies in strengthening the supervisory as-
pect of their training programs. Several States have held a series of
special institutes on improving methods and skills of the supervisory
group. Others have placed special emphasis on strengthening the
teaching skills of the State agencies’ field representatives.
Social Security Administration 61
In order to coordinate the efforts of the Bureau with that of other
national agencies and organizations in this area, there has been active
participation with committees of the American Public Welfare As-
sociation concerned with personnel and training, and with the national
committee of the Council on Social Work Education on the develop-
ment of teaching materials for schools of social work and for welfare
agencies.
atdren’s Bureau
During the year 1954 many individuals and State and local agencies
have focused attention on the need to take stock and evaluate their
health and welfare programs for children—what others know, how
far knowledge is being applied—what are the next steps. Such stock-
taking becomes imperative because of the overwhelming increase in
the number of children and the predictions about future increases.
The new knowledge of child development which was crystallized
in the Midcentury White House Conference on Children and Youth
is being put to work in an increasing number of towns and cities.
This knowledge is being tested in the laboratory of the community.
Chart 8.—CHILDREN IN THE UNITED STATES ARE INCREASING RAPIDLY
Ser
70 67 million
eee
fOLUPCL te ee) ter onwuceus
past
60 . ~
54 million
ar
As
eeees
coos
* | an
40 million
40
30
number of children (in millions)
20
10 O OV 5o BOO BOv
under 5 years %
1940
62 Department of Health, Education, and Welfare, 1954
The desire to apply new knowledge and skills still far exceeds the
actual application. Present programs are being critically examined
for their adequacy and in some places plans are being made to expand
existing services to make a start toward absorbing the several million
additional children who represent the increasing wealth of our human
resources.
The costs and methods of providing services are being reviewed to
see if there are ways of providing higher quality with greater effi-
ciency. The Children’s Bureau is participating actively in these pro-
gram reviews. ‘The interdependence of the child health and child
welfare programs becomes increasingly more evident in the light of
these evaluations.
Programs of the Bureau
The Children’s Bureau was created in 1912 by an Act of Congress
to investigate and report upon all matters pertaining to the welfare of
children and child life among all classes of our people. In 1935, the
Bureau was given the additional responsibility of administering the
grants to the States provided under the Social Security Act, Title V,
to enable them to extend and improve the services for promoting the
health and welfare of children, especially in rural areas and in areas
of special need.
THE RESEARCH PROGRAM
The legislative charge on the Children’s Bureau, “to investigate and
report upon all matters pertaining to the welfare of children” is
almost as broad as the complex of factors which shape our society.
A carefully developed research plan has guided the Bureau’s small
research staff in helping to carry out this legislative mandate. The
Bureau’s research activities include (1) technical studies on problems
affecting child health and welfare, conducted by the Bureau directly
or jointly with other agencies, or by other agencies with the Bureau
providing technical assistance and consultation; (2) statistical re-
porting in the fields of child health and welfare, with particular
attention to the State grant-in-aid programs administered by the
Bureau; and (8) research interpretation to provide public informa-
tion on the findings and conclusions of studies and investigations of
child life and development.
In its technical research, questions as to the effectiveness of various
specific programs and practices in child health and welfare have
received major emphasis. The following are some examples briefly
described. 3 a ae and deposits by States usually differ slightly, primarily because of time lag in making
eposits.
5 Includes transfers from the general fund of $3,734,000 for fiscal year 1952, to meet administrative and other
cost of benefits payable to survivors of certain World War II veterans as defined in title II of the Social Secu-
rity Act Amendments of 1946.
6 Includes interest transferred from the railroad retirement account under the financial interchange pro-
vision of the Railroad Retirement Act, as amended in 1951.
7 Represents checks issued.
Source: Compiled from Daily Statement of the U. S. Treasury and State agency reports.
Social Security Administration
93
Table 3.—Old-age and survivors insurance: Estimated number of families and
beneficiaries in receipt of benefits and average monthly benefit in current-
payment status, by family group, end of June 1954 and 1953
[In thousands, except for average benefit; data corrected to Nov. 5, 1954]
Family classification of beneficiaries
=H we eee ee we ww = ee ee + ee ee ee ee ee
Worker and wife aged 65 or over___________-_-
Worker and wife under age 65 !
Worker and aged dependent husband. --_-____
Roe wife aged 65 or over, and 1 or more
Cc
Worker, wife under age 65, and 1 child
Worker, wife under age 65, and 2 or more
SUNILGEP STIS) Sh cine ihe CU ee 2 ela
IN COCR WACO Weete. ee... ase = ede!
Aged dependent widower__._____._____-__--
Widowed mother only !
Widowed mother and 3 or more children_-__-
Divorced wife and 1 or more children_-__-___-
ee ea
7) (OUNCE FETT a8 Sp
rcianiclvemermer semen ie
1 aged dependent parent___._..____.._-_-__-
2 aged dependent parents__.__.....___-____-
1 Benefits of children were being withheld.
June 30, 1954
June 30, 1953
Average Average
Number|Number| monthly |Number|Number| monthly
of of bene- | amount of of bene- | amount
families | ficiaries per families | ficiaries per
family family
4, 689.4 | 6,468.8 |__.___.__- 4S O09%8 ai bn01 3.0 2s eee
SOLON AM AO TAK na eee eee 2, Dita Del O88 Gea eeees sas
2, 545.4 | 2, 545. 4 $49. 40 | 2,137.7 | 2, 137.7 $48. 20
1, 669.9 | 1, 669.9 53.80 | 1,443.1 | 1,443.1 52. 10
875.5 875.5 41.10 694. 6 694. 6 40. 10
904.9 | 1, 809.8 86. 30 781.8 | 1, 563.6 83. 70
.6 12 95. 60 .6 12 95. 20
7.3 14.6 75. 20 5.5 11.0 74, 20
9.2 18, 4 76. 00 7.9 15.8 75. 40
5.8 20. 4 79. 40 5.3 18.5 81. 20
.8 2.6 98. 90 9 2.9 97. 70
28. 5 85. 5 100. 70 24.1 (2.3 94, 00
16.9 ond 93. 40 13.7 64. 6 88. 10
Pela Orit Obra ||. gee oe 1.0352. Sait l G86i0) ce eee
585, 2 585. 2 41.00 498. 1 498. 1 40. 80
no .9 34, 40 a6 .6 33. 90
2.1 vaya 45. 20 2.4 2. 4 43. 30
118.2 236. 4 91.00 109. 4 218.8 88. 50
78.6 235. 8 112. 70 72.0 216.0 107. 90
68. 8 323. 4 112. 20 61.1 283. 3 105. 50
72 6 111. 50 2 5 95. 00
174.8 174.8 42. 20 159. 3 159.3 41. 40
73.3 146.6 72, 20 65. 5 131.0 70. 70
26. 0 78. 0 88. 30 23. 4 70. 2 86. 20
19,1 83. 0 92. 60 19.4 83.3 90. 10
212 21.2 42. 60 19.3 19.3 41.90
1.6 3,2 81. 40 1.6 3.2 80. 70
94. Department of Health, Education, and Welfare, 1954
Table 4.—Old-age and survivors insurance: Selected data on benefits, em-
ployers, workers, and taxable earnings, by State, for specified periods,
1952-1954
[In thousands, except for average taxable earnings, data corrected to Nov. 10, 1954]
Monthly bene- Calendar year 1952
fits in current- Em-
paver ; Benefit DEVUneD NS: fiscal er
status, end o year report- Amount of taxable
sore bee aS Workers earnings 4
State wages with
| ’ tax-
July- | able
+ ven Lump- ; ane eae Aver-
um- 5 onthly | sum |tember}| . age
nee Amount| ‘Total benefits | pay- | 1953 2 ings 3 Total per
ments worker
Totalee sca 6, 468. 8] $278, 702/$3, 275, 457)$3, 185, 282) $90,175) 3,650} 60, 000/$128, 800, 000} $2, 147
Alabama 22.2 ssc 94.3 3, 251 38, 518 34,090] 1,125 50 901; 1,443,000} 1,602
Mlasks sag oo eiae 8 3. 5 136 1, 572 1, 501 71 3 73 138,000} 1,890
ATIZONas been 28. 4 1, 152 18, 644 13, 230 414 18 304 533,000) 1, 753
Arkansas.) 22s 55.6 1, 906 22, 389 21, 845 544 31 474 655, 000 1, 382
@alifornia = 22 --- 625.1 23, 351 273, 376 266, 702 6, 674 291 4,995) 10, 760, 000 2, 154
Colorado 22s bane 2, 196 25, 741 25, 120 621 37 584 i; 020, 000} 1, 747
Connecticut. __-__-- 109.9] 5,340] 62,635} 60,914] 1, 721 56} 1,063] 2,441,000] 2,296
Delaware-__-------- 14.8 660 Ue: Wgpan 235 10 197 387,000} 1, 964
Dist-of Cols =—- 2453| 9 gal 042 12, 323 11, 908 415 27 541 973,000} 1,799
Wlorid ae Scene 160.3 6, 876 80, 178 78, 537| 1,641 86} 1,221; 1,800,000} 41,474
Georgigue:. 2 96.3 3, 283 39, 067 37, 768} 1, 299 71{ 1,210) 1,859,000} 1,536
Mawaliz. 22 fee to. 14.8 576 6, 740 6, 604 136 10 178 358,000} 2,011
Idaho. 22. See Pile 825 9, 751 9, 447 304 14 217 358,000} 1,650
TAGs eek 390.6] 17,874] 211,157; 204,172) 6,985 220| 4,265} 9,341,000] 2, 190
Indiana. 2 Se 186. 1 7, 952 93, 389 90, 896} 2, 493 84] 1,775} 3,699,000) 2,084
TOW8 ee eee 95. 5 3, 852 45, 009 43, 987 1, 022 70 825 1, 502, 000 1, 821
Kansase i a) eee te 70.3 2, 795 S2alad 31, 945 832 47 759); 1,350,000} 1,779
Kentnickys-os-e=s5 102.7 3, 792 44, 688 43,522} 1,166 49 841} 1,484,000} 1, 705
Louisiana__.-..-._- 75.1 2, 713 32, 198 31, 163 1, 035 52 896 1, 475, 000 1, 646
Mainei. = Sco tie 55.9 2, 296 26, 743 26, 213 530 20 370 610, 000 1, 649
Maryland 2. -.-..- 89.6 3, 847 45, 519 44, 023 1, 496 58 1, 040 1, 956, 000 1, 881
Massachusetts- ---- 282, 4 13, 230 154, 582 150, 923 3, 659 117 2, 169 4, 481, 000 2, 066
Michigan: ioe 22se. 280, 6 13, 039 153, 446 149, 118 4, 328 136 2, 935 6, 919, 000 2, 857
Minnesota. -_--__-- 113.9] 4,851] 56,881] 55,420) 1, 461 71| 1,082} 2,068,000} 1,911
Mississippi-_-__----- 45.8 1, 459 17, 369 16, 774 595 8) 497 664, 000 1, 336
Missouris2 #8. 164. 2 6, 875 80, 872 78, 517 2, 355 94 1, 709 38, 247, 000 1, 900
IMontana== soe — 22.6 929 10, 900 10, 633 267 17 221 388, 000 1, 756
Nebraska.-...------ 43,3 1, 720 20, 255 19, 647 608 34 459 791, 000 1, 723
Nevada_-...-.-....- 6.4 274 3, 238 3, 136 102 6 108 179, 000 1, 657
New Hampshire. -- 34, 2 1, 480 17, 290 16, 884 406 16 245 436, 000 1, 780
New Jersey...----- 250.0) 11,895} 140,139) 185,787] 4,352 129} 2,349) 5,140,000} 2,188
New Mexico---.---- 16. 5 563 6, 668 6, 486 182) . 16 234 353, 000 1, 509
ING Wey Ork 732.0} 33,785) 396,992} 385,560) 11, 432 466| 7,979) 17, 301, 000} 2, 180
North Carolina___- 107.6 3, 718 44, 196 42, 773 1, 423 71 1,331 2, 107, 000 1, 583
North Dakota----- neal 443 VA 5, 075 156 13 134 209, 000 1, 560
OI Og tae Sree 387.8] 17,595) 206,830} 201,040) 5,790 176] 3,742} 8,393,000} 2, 243
Oklahoma........- 70.0| 2,645) 31,138] 30,322 816 45 776| 1,339,000] 1, 726
Orecone eee 82.8 3, 621 42, 284 41, 338 946 43 653} 1,271,000} 1,946
Pennsylvania_____- 535.6] 24,548) 288,640] 280,508} 8, 132 230} 4,672) 10,221,000} 2,188
Puerto Rico_-_-_-_- 16. 2 420 4, 703 4, 595 108 17 324 225, 000 694
Rhode Island___-_-- 47.6 2, 205 25, 790 25, 146 644 19 392 785, 000 2, 003
South Carolina. -_- 56.1} 1,857; 22,076] 21,401] © 675 39 698] 1,125,000] 1,612
South Dakota----_- 16.5 630 7, 433 7, 210 223 16 181 301,000} 1,663
Tennessee__-__-_-- 95.8 3, 374 39, 896 38, 747 1, 149 63 1, 076 1, 720, 000 1, 599
ACOXAS 2 = eee see re 212.7 7, 932 94, 000 91,098} 2,902 193} 3,030! 5,316,000) 1,754
JORGEN oe ae eek 24.0 978 11, 536 11, 220 316 14 280 507,000} 1,811
Vermonte. oes. 19.0 783 9, 132 8, 938 194 11 131 220, 000 1, 679
Wircinigesas 2 esa 106. 5 4, 026 47, 572 46,209} 1,363 73\ 1, 2490)2) 088, 000| 1,672
Virgin Islands-_ _-__- 22 5 60 58 2 (5) 5 3,0 000 600
Washington._.____- 124,3 5, 559 64, 943 63, 456 1, 487 56 980 2, 011, 000 2, 052
West Virginia______ 92.1 3, 694 43, 300 42, 419 881 32 646 1, 264. 000 1, 957
Wisconsin. =--- 154.3 6, 774 79, 488 77, 367 2, 121 87 1, 390 2, 983, 000 2, 146
Wyoming__.______- 8.7 358 4, 258 4, 102 156 8 121 197, 000 1, 628
MOreloin ome eee 39.8 1, 724 19, 133 18, 948 16 eoeeciee 60 159,000} 2,650
IMamitlimente tee ee. (Oe lise agree ee ene ein Sete ee ee | ea 110 207,000] 1,882
1 State of residence estimated.
2 State data represent number of employers reporting taxable wages by the State of their reporting head-
quarters. An employer is a legal entity such as a corporation, partnership, or single ownership, for which
a single tax return is filed.
3 Preliminary estimate. State data represent workers employed in the State at some time during the
year. Workers employed in more than 1 State counted once in each of the States in which employed.
4 Preliminary estimate. State data represent taxable earnings distributed according to the State in
which earned.
5 Fewer than 500 employers.
6 Benefit data relate to persons in foreign countries receiving old-age and survivors insurance benefits.
Employment and earnings data relate to citizens of the United States employed by American oreo yers:
7 Relates to employment of officers and crews of American vessels.
°
Social Security Administration
95
Table 5.—Old-age and survivors insurance: Selected data on benefits, em-
ployers, workers, and taxable earnings for specified periods, 1952-1954
[In thousands except for average monthly benefit and average taxable earnings; corrected to Nov. 10, 1954]
Item
Benefits in current-payments status (end of period):
INSITE) OV ase ee ee ge
ROS ais meer es eee sn eG ea Be a ot oe
HEATED Lila sen ie SE ie a ees et eo dk ee
RO iricins eet ee ee ee
CE aces 1 er rr
Waite Om aUISHANG Saoee sooo sos eee asl eee 2
ni icysememeeee ee See tet ee ee! see ee
Benefit payments during period:
rOnvennyeDanOn(Sca. . 22-20 2225-22 2k a eee
OT ee RRS eR ene a es a ea
SO SS AE a ae Anne Sere
mpmepeetrtme ay MONG. 2
Estimated number of living workers with wage credits (mid-
point of period—Jan. 1:1!
PRUE MLNS ROG mentee ee a a ae
Omen y.put-not fully insured_......-. 22-2 2 ese.
Ce ae ee ee ee
Estimated number of employers reporting taxable wages, 1st
antClenceaieyCar = 226i koe Tel ta Se Me ke
Estimated number of workers with taxable earnings-_-_____._-
Estimated amount of taxable earnings_--_.-...-___----_---___-
PAMVeoharemaxaplerearmings: 9 oe es
1954 | 1953
Fiscal year
6, 468. 8 5, 573. 6
3, 519. 4 2,977.5
959.1 826. 6
1,111.9 1, 003. 3
586. 3 499.0
267. 7 244.8
24. 4 22.5
$278, 702 $232, 999
$182, 334 $150, 124
$26, 302 $22, 050
$34, 770 $30, 541
$24, 016 $20, 332
$10, 249 $9, 015
$1, 030 $936
$51. 81 $50. 42
$27. 42 $26. 68
$31. 27 $30. 44
$40. 96 $40. 75
$38. 28 $36. 82
$42. 26 $41. 68
$3, 185, 282 $2, 551, 224
$2, 068, 404 $1, 624, 605
$318, 614 $252, 994
$798, 264 $673, 625
$90,175 $76, 268
93, 600 90, 900
69, 200 66, 600
2) 2)
24, 400 24, 300
3, 620 3, 645
$137, 000, 000
$2, 246
Calendar year
61, 000
2:
1952
4, 593.8
2, 372.3
668. 3
896. 8
421.7
214.0
20.6
$161, 739
$99, 592
$15,170
$24, 009
$15, 162
$7, 053
$754
$41. 98
$22. 70
$26. 77
$35. 95
$32. 95
$36. 60
$1, 924, 107
$1,191, 351
$193, 525
$539, 231
$58, 270
87, 800
62, 600
25, 200
3, 635
60, 000
$128, 800, 000
$2,147
1 Estimates of insured workers have not been adjusted to reflect changes in insurance status arising from:
(1) provisions that coordinate the old-age and survivors insurance and railroad retirement programs, and
(2) wage credits for military service.
of persons with taxable earnings reported on more than 1 account number.
tion is substantially less significant for insured workers than for uninsured workers.
2 Not possible under the 1950 amendments until July 1, 1954.
Not available.
Estimates are only partially adjusted to eliminate duplicate count
The effect of such duplica-
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100 Department of Health, Education, and Welfare, 1954
Table 8.—Maternal and child health and welfare services: Grants to States for
maternal and child health services, services for crippled children, and child
welfare services under the Social Security Act, by program and State, fiscal
year 1954 * .
{In thousands]
Maternal and child health ; ‘
sarvics Services for crippled children Child
State welfare
services
Total Fund A | Fund B Total Fund A | Fund B
United States____-__- $11, 898.1 | $5, 936.3 | $5,961.8 | $10, 727.1 | $5, 305.4 | $5,421.7 | $6, 755.2
AISbAIIa=. ere eas fee ale AAT 126.1 321.6 362. 1 118.6 243. 5 229. 0
(Milas ka. 6 oaees oh arn eae 80. 0 47.1 32.9 142.1 45.9 96. 2 36. 4
FA PIZOUNe 82 eee ec oe eee 110.8 64, 2 46, 6. oc eek ene eee 64. 0
ATKANISAGE ee es eee 241.0 89. 0 152. 0 292. 5 89.0 203. 5 172.3
@ahifonliaes eS eee 484.1 288. 7 195. 4 318. 1 233.9 84. 2 214.5
GOlOTADO =o Oe ee eet 194.0 77.3 116.7 90. 6 70.6 20. 0 72.7
Connecticut. .0 oo eee ees 124.3 84.1 40. 2 182.9 79,1 103.8 65.9
Melawares..oo- 4 See 84.5 50. 6 33.9 69.1 49.3 19.8 39.7
District of Columbia___-_-_- 154. 3 63. 2 91.1 132. 2 55. 4 76. 8 28.9
MIOTIGAS cs Fe 325. eee 247.7 108. 1 139.6 180. 8 97.0 83. 8 124.8
COOT ola is ee She a eae 431.0 134.9 296.1 360. 2 125.0 235. 2 294.9
MLAs ee le ea 136. 2 67.5 78.7 138. 5 55.1 83. 4 42.0
GATOS he See eee 85. 8 59. 4 26. 4 78.5 Dene PAT: 40.0
Dts Pop hoe oe ar ee eB le 314.7 233. 6 81.1 353. 6 200. 6 153. 0 163.1
HG OVe lite ate is 15 ee eae kane aes 193.3 137.0 56. 3 15520 103.0 52.0 61.6
BROS tits Weeeb Stee eames BAB St SIG RLO ES 15332 108. 0 45. 2 211.5 96. 5 115.0 157. 4
ICaTSASEe eee oe ee eee 127-2 87.4 39.8 120.9 81.1 39.8 109. 4
KcOntiGkey is toe Uc nee 334. 8 118.6 216. 2 355. 0 aia ln 243.3 232. 1
HOWISIANa on ou oe eee eee 311.5 119.9 191.6 238. 2 106. 0 132. 2 168.9
Mate eae ee ee 92. 2 64. 5 Dou 87.1 62. 7 24.4 71.6
Manylandase ee ee ee aa 322.7 97.7 225.0 260. 7 89.6 alate i 97.0
Massachusetts... --_._._.. 322. 6 139.8 182.8 192.6 128.1 64.5 76.6
Miienivamee =. eat eens 340.8 204. 6 136. 2 315.3 WES A! 142. 2 ZAOS7
Minmnesotae ce. SS ee ee 224. 4 118. 8 105. 6 216.3 104. 8 111.5 164.3
Mississinpic. Je oes eee 338. 4 108. 4 230. 0 292.8 98.8 194.0 213.3
NISSOUN. ea ee eee ee 250. 2 129, 4 120.8 250. 8 118.6 132,;2 169.7
Montand. 224. 3-02 ae ae 85.1 59. 0 26. 1 89. 7 55.9 33.8 61.7
Nebraska 5.22 =. 6. oe oe 91.3 72.6 18.7 103. 9 70.0 33.9 40.3
IN@vaAdaa: 252 eee ees Goa 42.5 22.6 52.4 32.0 20. 4 33.9
New Hampshire---_---.---- tire 54.9 16. 4 84.0 bout 30.3 48.8
New J Grsey. likenesses 145.9 141.3 4.6 Viseo 127.8 45.7 78.3
New Nioxico le 42322 ee 108. 7 65. 5 43. 2 76. 0 60. 7 15.3 69. 4
UNIO W COD Kee ae ne ele 436. 0 344.9 91.1 337.0 298. 4 39.1 183.1
North @aroling 22 22s 523. 6 150.0 373.6 425.3 142.9 282. 4 333. 0
INOLED Dakotas. 225 ee 86. 8 60. 4 26. 4 85,2 57.9 Vis 44.8
Ohio es OM ee Pa 383. 2 229. 5 153. 7 328. 6 196, 2 132. 4 162. 7
Okdahomae.. Meee. aie 160. 4 93. 6 66. 8 236. 2 91.9 144.3 142. 2
Oregons easy ULE OT aes 110. 4 79.5 30.9 99. 4 7s ya | 26.3 57.5
Pennsylvania. 22 22 9 467.5 265. 4 202. 1 446. 2 243.9 202. 3 298. 3
Puerto wico eG ee 370. 2 129.6 240. 6 315.7 113.0 2025. 162. 6
Rhode island*--..-. ae 83. 4 59. 6 23.8 101.1 57.6 43.5 39.1
South- Caroling. 2... 7.2 262. 1 100. 9 161. 2 284. 4 98. 4 186. 0 AO Sp
South Dakotas es 20 sscuEs 63.9 41.0 22.9 79.1 57.8 21.3 71.9
TNCITIESSOG 2a oe Abs Soe 424.6 124.9 299. 7 361.2 118. 4 232.8 77 A a
TRexaseee ties. tue? ss 519. 5 247.6 271.9 507. 7 PAM BS Fi 296. 0 321.1
Galt ok ae a ea 125. 4 64.6 60. 8 114.7 60. 5 54, 2 57.6
MOTION uaa ee Se a se ecm 78.8 52. 4 26. 4 (PPI 51.4 aie 5251
Wircin wslands.2 5 ste eee 80. 4 44.3 36s 64.0 44,2 19.8 30.2
Welroinigeoe Roc ea ee 344, 2 125.5 218. 7 310.1 115.8 194.3 213.3
Washington 2a sue sau 169.9 99.3 70. 6 146, 4 89.3 67.1 109. 7
Wiest. Virginia 2307) ee 219.7 94.0 125.17 144.7 86.9 57.8 177.8
Wiaseonsinses es. aun ee 197.1 126. 2 70.9 246. 6 112.9 Bess 169.8
Way OITETIO NaS. 50 tas ee 76. 2 49.4 26.8 53. 4 32. 4 21.0 40. 4
1 Based on checks issued less refunds.
Social Security Administration
101
Table 9.—Federal credit unions: Number of members, amount of assets,
amount of shares, and amount of loans outstanding Dec. 31, 1935-1953
ee of Rca '
reporting umber o
Year credit members
unions ! ;
JORIS. oe Se ae ek ee a 762 118, 665
Oo Gm ere a 1, 725 307, 651
ths 2, 296 482, 441
OR eh, le oy pl 2, 753 631, 436
JIGERS oo oa jee ee 3, 172 849, 806
SUEY oo eile nee pe a 3, 739 1, 126, 222
IME DL. 2 et Ne 4,144 1, 396, 696
4) eee cae 4,070 1, 347, 519
iC NG oc See SO ee 3, 859 1, 302, 363
A eee eee 3, 795 1, 303, 801
TOS ae yl See 3, (57 1, 216, 625
LMU LL 3, 761 1, 302, 132
a 3, 845 1, 445, 915
POSS a os a ak a RE 4, 058 1, 628, 339
O80 a io 4, 495 1, 819, 606
DAUR es = ase i oe TE 4, 984 2, 126, 823
ey eon es 5, 398 2, 463, 898
OD eee eer ae OS Sl ee 5, 925 2, 853, 241
LON epee ee! 6, 578 3, 255, 422
Amount of
assets
$2, 368, 521
9, 142, 943
19, 249, 738
29, 621, 501
47, 796, 278
72, 500, 539
105, 656, 839
119, 232, 893
126, 948, 085
144, 266, 156
153, 103, 120
173, 166, 459
210, 375, 571
258, 411, 736
316, 362, 504
405, 834, 976
504, 714, 580
662, 408, 869
854, 232, 007
Amount of
shares
$2, 224, 608
8, 496, 526
17, 636, 414
26, 869, 367
43, 314, 433
65, 780, 063
96, 816, 948
109, 498, 801
116, 988, 974
133, 586, 147
140, 613, 962
159, 718, 040
192, 410, 043
235, 008, 368
285, 000, 934
361, 924, 778
457, 402, 124
597, 374, 117
767, 571, 092
Amount of
loans
$1, 830, 489
7, 330, 248
15, 683, 676
23, 824, 703
37, 663, 782
55, 801, 026
69, 249, 487
42, 886, 750
35, 228, 153
34, 403, 467
35, 155, 414
56, 800, 937
91, 372, 197
137, 642, 327
186, 218, 022
263, 735, 838
299, 755, 775
415, 062, 315
573, 973, 529
1JIn the period 1945 through 1953, the number of operating and reporting credit unions was the same.
In other years, the number of credit unions which reported was less than the number in operation.
Table 10.—Federal credit unions: Assets and liabilities, Dec. 31, 1953, and
Dec. 31, 1952
Percentage dis-
Amount tribution
Assets and liabilities
Change dur- | Dec. 31, | Dec. 31,
Dec. 31, 1953 | Dee. 31, 1952 ing year 1953 1952
Number of eperaHing Federal credit
MGM OMS emer eee es Ss Se eet 6, 578 5, 925 GOS, | ay eet ae ee oo
MOLAVASSOUS = 2.) S52 js52-e2 3 ee $854, 232, 007 | $662, 408, 869 | $191, 823, 138 100. 0 100. 0
aa POMMOMIDCTSs et ss ate 573, 973, 529 | 415, 062, 315 158, 911, 214 67.2 62. 6
JLLb. 2366s 76, 710, 132 66, 033, 714 10, 676, 418 9.0 10.0
United STApeS ONS = Fe 86, 646, 022 85, 859. 900 786, 122 10.1 12.9
Savings and loan shares_____....---____- 95, 728, 053 80, 155, 252 15, 572, 801 135 9. L251
Loans to other credit unions__..._.__-__- 15, 571, 638 10, 297, 188 5, 274, 450 1.8 1.6
(UNC ASSCLS ose el 5, 602, 633 5, 000, 500 602, 133 sari .8
MeoOtaiiapilities.- a2. a2. 225 5 alo. 854, 232,007 | 662, 408, 869 | 191, 823, 138 100. 0 100. 0
INGeesmavanlOse-o oo. -a2 ol 21, 481, 388 16, 091, 405 5, 389, 983 205 2.4
Accounts payable and other liabilities___ 2, 273, 236 1, 715, 599 557, 637 nes ce
SHO PEY RESIS a ul a las 767, 571, 092 597, 374, 117 170, 196, 975 89.8 90. 2
Reserve for bad loans_-_____..-_.---.---- 24, 811, 688 19, 571, 805 5, 239, 883 2.9 3.0
Special reserve for delinquent loans_-_-_-_-- 1, 367, 212 988, 926 378, 286 oe al
36, 727, 391 26, 667, 017 10, 060, 374 4,3 4.0
IiMaLvIGed Promisso. - 2082.2. ole.-.--..
isd
teeter Bete
ice
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aad
Public Health Service
Health of the Nation
The improved health of the American people is one of the great
achievements of the twentieth century. The average life-expectancy
is longer and the chances of preventing or curing disease are greater
than at any prior time in our history. This achievement has been
made possible by the advance of science in many fields and by the
application of medical and public health knowledge.
Today, medical science is making rapid progress against diseases
which once appeared to be insoluble mysteries. Among these, the
major killers and cripplers are heart and circulatory ailments, cancer,
arthritis and rheumatism, disorders of the nervous system, and mental
disease. Infectious diseases caused by viruses still present many un-
solved problems.
These challenges require teamwork by health agencies at all levels
of government with the many professional and voluntary groups
working in the health fields. As a member of the Nation’s health
team, the Public Health Service continued throughout the past year
to strengthen its working relationships with other organizations dedi-
cated to the improvement of human health.
HEALTH RECORD
The estimated general death rate for 1953 1 was 9.6 per 1,000 popula-
tion, approximately the same as in the past 5 years. There has been
little change in the difference between the male death rate and the
female death rate, the former being about 11 per 1,000 and the latter
about 8 per 1,000. |
Infant mortality continued to decline, with a death rate of 27.9 per
- 1,000 live births in 1953. ‘The maternal death rate was 5.6 per 10,000
1 All vital statistics are given for the calendar year.
103
104. Department of Health, Education, and Welfare, 1954 ~
live births. These may be contrasted with rates of about 40 infant
deaths per 1,000 live births and 23 maternal deaths per 10,000 live
births in 1948. ,
Among the leading causes of death, the only disease to show a sub-
stantial decline in recent years has been tuberculosis. A decrease of
about 20 percent, from 16.3 per 100,000 population in 1952 to 12.5
per 100,000 was reported in 1953. The use of new drugs has been
chiefly responsible for the reduction in deaths. In contrast, the num-
ber of tuberculosis cases reported to the Public Health Service has
been decreasing by only 3 percent.
Death rates from diseases of the cardiovascular-renal systems and
cancer increased slightly. The death rate due to heart diseases and
other circulatory disorders was 501.4 per 100,000 population in 1953,
as compared with 498.8 per 100,000 in 1952, while the corresponding
cancer death rates were 144.7 and 143.4 per 100,000. ‘These causes ac-
counted for two-thirds of all deaths in 1953.
There were no significant changes in the death rates due to motor-
vehicle accidents and other accidents. An outbreak of influenza early
in 1953 contributed to an increase in the death rate due to influenza
and pneumonia from 30 per 100,000 in 1952 to 33 per 100,000 in 1958.
Among the communicable diseases, the most notable increase oc-
curred in the number of reported cases of infectious hepatitis, from
17,482 in 1952 to 33,700 in 1953. The most striking increases were in
the West South Central States. Poliomyelitis incidence in 1953 was
below the nationwide epidemic incidence of 1952. A total of 35,592
cases, both paralytic and non-paralytic, was reported in 1958, as con-
trasted with the corresponding figure of 57,879 in 1952.
BIRTHS, MARRIAGES, AND DIVORCES
The estimated birth rate in 1953 was 25.1 per 1,000 population.
About 4,000,000 live births occurred in 1953, although the number of
registered births was slightly under that figure (3,909,000). About
92 percent of all registered births occurred in hospitals and 96 per-
cent were attended by physicians, in contrast with corresponding
ratios of 87 percent and 87 percent in 1935.
There was no significant change in the numbers of marriages and
divorces in 1958, and the corresponding rates were also substantially
the same. The marriage rate was 9.7 per 1,000 population and the
divorce rate, 2.5 per 1,000.
Funds and Personnel
Total funds available to the Public Health Service in 1954 were —
$266 million (see Table 1, page 164). About $210 million of this
Public Health Service 105
amount was in appropriations and authorizations; reimbursements
for services to other agencies and unobligated balances from prior
years for hospital construction grants and for construction of other
facilities constituted the balance. _
The number of full-time employees in the Public Health Service
at the close of fiscal year 1954 was 15,315 (see Table 2, page 165). This
number included 1,211 members of the regular commissioned corps
of the Public Health Service, 1,253 members of the reserve corps on
active duty, and 12,851 full-time Civil Service employees.
Health Emergency Planning
An important task of the Office of Health Emergency Planning
is to coordinate emergency activities of the Public Health Service
and to integrate these with activities of other Federal and national
agencies, such as the Office of Defense Mobilization, the Federal Civil
Defense Administration, the Atomic Energy Commission, the
American National Red Cross, and with other executive departments.
Regional representatives of the Public Health Service, the American
National Red Cross, and the Federal Civil Defense Administration
held a series of meetings to discuss collaboration during natural dis-
asters. Results of these meetings were presented to the State and
Territorial Health Officers Association, which recommended similar
cooperation between the Red Cross and State health personnel. Such
agreements have been reached in 6 States and are being negotiated in
7 other States and Puerto Rico.
In addition to supplies and equipment, the Public Health Service
was called upon to furnish technical and epidemiological aid during
the Hidalgo County (Texas) flood in April 1954. During the Iowa-
Kansas flood in June, water purification units and assistance in train-
ing local operators were furnished to the Iowa State Department of
Health. Mobile water treatment units and consultation were fur-
nished to the Kansas State Board of Health during the water shortage
in Kansas and Missouri in March.
Public Health Service officers were provided for assignment to
critical positions in the Health Office of the Federal Defense Admin-
istration, including regional medical consultants, directors of casualty
and blood services, and radiological health consultants. Within the
Service, an Advisory Committee to the Surgeon General on Health
Emergency Planning was established to assist in developing policies
and plans on emergency activities and to facilitate interchange of
information among the various programs of the Service.
339010558
106 Department of Health, Education, and Welfare, 1954
Pe ee
Public Health Methods
The Division of Public Health Methods provides staff assistance to
the Surgeon General in the fields of public health administration,
research, practice, needs, and resources. It gives consultation in these
fields to governmental, voluntary, and professional organizations,
advising on methods of evaluation and formulation of programs. It
participates in surveys, studies, and conferences and collects, analyzes,
and publishes data for use by the Service and other health organi-
zations. The Division also publishes the official technical journal of
the Service, the monthly Public Health Reports.
HEALTH MANPOWER SOURCE BOOKS
Present plans call for the compilation of at least eight sections of
a series of Health Manpower Source Books. Sections on physicians.
and nursing personnel were completed in fiscal year 1953 and Sections
8, 4, and 5 in 1954. Work on sections 6, 7, and 8 was in progress
during 1954.
Medical Social Workers (Sec. 3) brings together data on the num-
ber, distribution, employment, and personal characteristics of medical
social workers, plus information on education and training facilities,
their utilization, and needs.
County data on health personnel and facilities im 1950 (Sec. 4)
presents data from the 1950 Census for 16 health occupations and for
facilities in such geographic units as trading areas, standard metro-
politan areas, county groups, health service areas, and State hospital
regions. ‘The numbers of health personnel are related to population,
land area, purchasing power, and other health resource and general
economics data.
State data on health occupations and health industries, 1950 (Sec. 5)
presents data on the occupational and industrial distribution of per-
sonnel in 16 health occupations for each geographic region and State,
and according to age, sex, and conditions of employment.
HEALTH SERVICES AND FACILITIES
To bring together relevant facts on the problem of care in prolonged
illness, the Division prepared a comprehensive Source Book on Care
of the Long-Term Patient. The 69 tables of this publication are
grouped under four major headings: (1) persons with long-term dis-
abling illness; (2) the patient at home; (8) the patient in an institu-
tion; and (4) integration of facilities and services. Three appendices
list data on the location of rehabilitation centers, chronic disease hos-
pitals, and chronic disease units in general hospitals.
Public Health Service 107
A 1950-52 Supplement to the Digests of Selected References on
Chronic Iliness was issued during the year. Together, the two vol-
umes contain some 1,150 digests classified under the general headings
of dimensions of the problem, contributory factors, prevention and
control, rehabilitation, noninstitutional services, institutional services,
design and construction of institutions.
An analysis of variations in income and expense ratios in nonprofit,
short-term general hospitals in 1951 was completed. A study of 11
home care programs was undertaken as a joint project of the Public
Health Service and the Commission on Chronic Illness. The Di-
vision, aided by the American Public Health Association, has com-
pleted a study of 12 selected regional plans of hospitals, medical
schools, and health departments for coordinating medical activities
in urban and rural areas.
A study of the costs of medical education in Emory University
has been started to assist the university in analyzing some of the ad-
ministrative problems of financing its medical school. It is hoped
that the study will develop procedures that will prove helpful to
other institutions.
STATISTICAL STUDIES OF ILLNESS
A clearinghouse on sources of morbidity data serves as a means
of interchange of advice and experience in planning and conducting
statistical studies of illness. The first listing of clearinghouse
projects (Sources of Morbidity Data, Listing No. 1, 1953) was issued
in September 1953. It is a classified list of studies, citing the types,
purposes, and methods of data collection; the organization conducting
the study; the names of principal investigators; plans for publication
and references to reports published; and the name and address of the
person prepared to give additional information.
An analysis of consolidated data from six surveys of illness in
selected areas of the United States shows case rates, by age, for about
100 disease categories. Data on hospitalized cases, by age and sex,
are included for 35 diagnostic groups. Consolidation of findings
permits study of the duration and severity of illness in terms of days
of disability, days in bed, and days of hospital care.
An article published in Public Health Reports summarizes the
results of a study of trends in two 6-year periods in age-specific death
rates for cardiovascular-renal diseases, ulcers of the stomach and
duodenum, hernia and intestinal obstruction, and diabetes mellitus
among white men and white women.
Long-term records of surveyed families in Hagerstown, Md., facili-
tate investigations of the subsequent history and illness experience
in families that have been included in earlier surveys. Special studies
|
108 Department of Health, Education, and Welfare, 1954
en a ee
completed or in progress in Hagerstown during the year include an
analysis of the effects of radiation on the offspring of radiologists; _
preparations for a proposed followup study of persons found in earlier
studies to have evidence of pulmonary or cardiac disorders; and an
investigation of the health of older persons and their availability
for work.
National Institutes of Health
The conduct and support of medical research is the major respon-
sibility of the National Institutes of Health. In its own facilities
and through its program of grants and fellowships, the NIH works
with medical schools, universities, private foundations, voluntary
health agencies, and pharmaceutical laboratories, in advancing
medical science.
With the Clinical Center added to its basic science laboratories,
the National Institutes of Health now combines research in the
processes of disease with study of the patient and application of
research findings. By July 1954, the values of integrated basic and
clinical research were becoming evident in important findings reported
by the several Institutes. A full year of operation of the Center had
shown that the plan is workable and holds great promise for the
future.
The Clinical Center
Beginning with a single nursing unit of 25 beds, which received
its first patients on July 6, 1958, the Clinical Center grew according
to a planned schedule. By the year’s end, 250 beds in 10 units and
approximately 65 percent of the total basic and clinical research area
were available for use. It is not expected that full capacity will be
reached until 1956.
During the year, 865 in-patients from all parts of the country were
admitted. ‘They were distributed among the Institutes as follows:
Cancer, 202; Heart, 189; Arthritis, 82; Neurology and Blindness, 172;
Microbiology, 176; and Mental Health, 44. The average length of
stay was 30 days. --8- ~~ een 19 113, 795 2 OUMAO see eines 5 eb at ene ors
INe@ we MexieOsa 2—--- coos 22-2 oes 5 SOOO ate Lia eee tet oe lente eo ne tee aed
INNA GRW IE 2 CGO) oh isl ey a a 444 5, 297, 016 80 364, 100 12 139, 579
Soren © arora —.- 2 oe es 68 613, 624 10 AQOAG Vee ae Sede seen’ Sos as
INotimnDakOtae..22--...~5-5.--2-22 3 TAROS3S eee ee seas tase eels eee ec aE Soon eS
Co ES eae ae 123 | 1,151,069 21 90, 201 3 20, 785
COLES EDU DOS COS a 28 223, 490 5 20; 963. cles ooo oe IE eee Lee ee
WreConewrt ee cw ee 24 2O0SYS Toy ate ean [ee eet ee ccnn stan le acon ts won we
PennSVIVENIa. co ocost col see eu 207 1, 948, 034 22 91, 614 7 85, 644
Rinotemsian@es ss. 24) 2.2L ole 10 59, 681 2 ORGS (Uae once eon ceae cee
poutmpmearounda.- -_-. 2.2. s.--- = 12 Tip taceddt ant Maa) Ss oJjcoen 1 6, 426
SOoT DEG) ey Se 7 SORLEEN Rees ee pe emer aoe fee OL at he ne oe het
pROnMOSSOG sees - 22 52----.---s------2 49 400, 597 1 4, 250 7 108, 508
NESS a a 66 472, 834 7 27, 946 5 51, 990
URE ho a 28 474, 967 8 31, 812 3 39, 073
Wenimonteesseee. occ - S55. 8 il 75, 055 1 5, 250 1 14, 931
WANES Wie LE 31 215, 538 2 9, 465 1 2, 338
Wiasnimetonere ses o sles) 58 539, 169 12 51, 786 1 14, 800
OS Te a Re nl i a 1 rae LM Deity SAE ARR | A SelM hand (ae ala Ra por (deg Ne ae fa 2
ES ONE I ee eee ee 58 5238, 944 13 Pe URE: S135) cabana aS Rmmpn ee Ad Lae
eae Sd Lak aca ca dag bee eee See Solana cate dacas lamcom nde ede asnamonnes
eee a dL ab ag ult dae fare base See aide caaetacaclannuccocdclaadetemennnd
Ee tk keene wnsace 2 Peg rare as carat carton tae ems Oo eee Sea mararenotd
CA Oo a a 8 41, 859 2 Bisel ee seamen
mee here et ene. aes oe eo ee Ion oo dan oetocdeccalasece sete |socossa esos
Wanadae sso. il Re ie Reh 2 18, 000 8 SSR7 28" ee eal sate cn ees
Reet te osc ct ener c~ noe 2 35, 000 20 OG5806 {onan ee wos lasaaensetee
SEA eee uammiane whe kL ecco e e 1 $5. 0004 ice cba le wtics acrewate 6, 780
Pra eCeri tie fides ote oS lewon sea nts 3 26, 000 2 Pe Ma ces Sas es Saree o's we enw
WOME Ree eee se ve Sek 1 6, 534 9 ANE Od kee mene yd Pepe ms aol gar
ermeranene: Wen, foe 2c... -.- 2 AOS EOE ete t eek a eer eee ace e ees Lok ae oa ete
i lS 2 PS5O00 Cn ee ee elec eee ee Ree
TPaYO TES ej SSeS ac 1 ROO Dial ae ae See | ae etre ener [Ieee ool | SAE CS ee
NouUihes t@iCats._- 25-26. see lke 1 (eo od tk ge ee OP BES nah A ony ORI OP Home ee WRK
RasOsla vine. cele! 1 D7 LL Sn been eee oe oe eae |e See Cie eee Cee eee
alc RaEAa LGM ns fires = ues SUC oe seu ed Sl ee | eat ooo (oe ae 1 9, 800
el re Pe co elena deauucalecksawanoeue 1 Bolas oe eee at
Ce OMe eee rae ee Soe Se et eee 8 CIN ALG ech e)| aeeet eee
2 8 SI SIS aS ea) (ec MRR aN gm 2 TO BIOs ovuwece. <[oseeewe as een
Rat se ey oe 1 BOO Ans ehen cube eeu meee ace
ee eee ec bc teads 1 Gr Ot one oe tee cmem Meco
Fellowsin Government institutions_|-_-........|.----------- 10 COAL Toes ee Noes ae
Reh caetons kcncece 2,855 | 29, 951, 150 490 | 2,132,004 85 1, 091, 344
168 | Department of Health, Education, and Welfare, 1954
Table 4.—Payments for teaching grants, traineeships, and ia he grants,
fiscal year 1954
Teaching grants Traineeships Training grants
State or country Traineeships
Pee Amount oe Amount ee provided for Sue
Ms under grant 8
Ota] Sens he eee 323 | $5, 894, 184 488 | $7, 444, 832 251 818 | $4, 222, 806
Alabama tesceese = eee 4 70, 000 4 70, 000 |2 2222 22| 2S eee
ArizOna 2222-822 22le.bete lle ne boos ede ee este ses 2 22 2 Se
AT KANSASS Sates once eee 3 64, 991 3 64,991 |2c 252255 | ee eee | eee
@alifomia.-e else 18 332, 800 31 452, 391 19 62 273, 318
Colorado asi 22 ine ee sree 2 50, 000 6 99, 069 4 7) 103, 811
Connecticut=--- eee 4 79, 894 9 147, 364 8 23 121, 810
Delaware. 22 oe eek cee 2 eb loose ee | Ses cee ee ee
District of Columbia_---._- 14 246, 643 18 297, 697 9 41 195, 818
Bilorid acesee as ee teens 3 50, 000 4 58, 000 pA el ls 8, 000
Ge0rsin’ 2 fee ee eee 7 152, 660 7 125, 400 4 7 43, 660
Idaho. wo2- 2.22522 isn nee als Sacco ket oot toa. 2n| be Sk a ee
Dlin oise rs SST eeke see 20 397, 104 29 485, 820 16 59 293, 899
Inidignaes:2 sence = see tere ee 2 29, 968 7 76, 555 6 14 77, 088
TOW ae eee yee eee 7 135, 059 8 129, 027 3 14 62, 394
CATiSASh eee esti eee vereme 4 79, 050 13 147,115 9 15 99, 065
Kentucky ie nee ee ers 5 76, 916 9 122, 705 4 7 64, 872
Lonisiana <4 te eae eee 8 150, 000 13 187, 513 6 26 90, 313
Aine 2.8 oo. oo eee (Lee ee tora cn ee te Se eS fe occ oT
Maryland iat os. oe eee 10 213, 558 14 233, 808 5 14 58, 750
Massachusetts__.---.------- 16 244, 124 36 463, 525 35 120 572, 801
Michigan 2 tp a2 e522 sess 9 139, 819 14 179, 506 | . 5 16 67, 727
Minnesotasos. 2 22-- see ee = 9 141, 844 11 157, 834 10 44 179,176
Mississippicusess= ae ce aeee ee 3 25, 000 3 25, 000! | 2 -- 222 2S ee
Missourim those 18 311, 940 24 405, 242 6 22 110, 736
Montana. Joie occ 2 eb ec lio ie i eke | a Pr es | aaa aa eee
INebraskat sonst osetee seen 8 125, 000 11 146, 708 3 3 27, 290
Nevada.w su. 22222 cso oii. | Son neon | ee enn oe se eee eee
New Hampshire--.-_------- 1 5, 000 1 §, 000 ||-- = cee ee
New Jersey <2---6-siese-0-| eons | sececc ccc ces bee leo le oe cc
New Mexicoii 2222. 2-02.20) o. 2. 2) oo. -- ss 2nne| se ooceaetom see cecsces| eee ee eee
INGWAY Ofer er aaene ee 34 659, 534 51 832, 483 24 84 487, 032
North Carolina--...-------- 13 220, 280 19 259, 050 11 27 273, 285
INOrtheDakotasess2-oss-= == 2 20, 000 2 20, 000 || --- oe e e
Oig ee eres see ST neans 13 237, 641 21 327, 634 12 33 221, 963
ORlahomai es. ee eee 3 65, 000 3 65,000 |... 022 |2aes22 22 eee
Oregon es ait Rea 4 68, 999 4 68, 999 |---- Le | See eee
Pennsylvania. -..-.--------- 26 470, 112 39 592, 793 23 78 332, 222
Rhode Island. ose 222 |'s2 | a 2s | ca ee ee a |
South Carolinas ---2-4.- == 2 50, 000 3 55, 000 1: Seeeeen ses eee 5, 000
South Dakotas ----22-4225- 2 18, 200 3 31, 200 ||_2.-. oS ee eee
Tennesse@ -. ee ass e eae es 10 183, 862 16 253, 777 uy 41 216, 345
CXaS ae ae ee eee eee 8 135, 8€8 1193 155, 152 5 2 25, 084
(Oia We vee oe on noes 4 78, 000 vf 98,115 4 5 30, 498
Wermontens eo tee eens 4 65, 650 4 65, 650 ||-2 22S Se ee ee
Vir cinint® seer eoeneeee ee 6 102, 990 ze 119, 902 3 3 31, 612
Washing tone. se ee 4 69, 948 8 146, 345 4 16 78, 337
West Virginians oe te 2 19, 958 2 19, 958 ||. 22 uL eee Se ee
WAsconsint# ses neers 8 255, 772 7 197, 088 3 15 65, 484
Wyoming =. ic cane en cl eel a a ee
Alaskai 22 ose yc I ee ao ILE ee
awa tie es ee ee are | ere serene eee 1 5, 416 ]: | Se e88 Seer eeeee 5, 416
Puerto Rico#<2 cee eee 3 51, 000 3 61,000 |... -2.|2 222222 ee | ee
Virgin Islands 2.02. ie ee oe |e occ Joo flc ee oL| 2 2 Se a ee
Public Health Service 169
Table 5.—Payments to States, fiscal year 1954
[In thousands]
Venereal * | Mental Hospital] Com-
State disease babes General| health | Cancer Pas con- | munity
special aeateol health | activi- | control control struc- facili-
projects ties tion ties
UCTS 2p a ar 2 $3,105 | $4,274 |3 $10,693; $2,308 | $2,213 | $1,054 | $88, 219 $4, 125
AGB OR Cte a 131 101 305 52 58 29 1, 791 96
IATIZOU Me eeeeee ce — = oe a 24 49 75 11 Sine eee SHIR hue ae
IAT GTINE ee 90 72 198 31 38 25 2, 026 81
Waliioriiaee=s=- <2 2--" 5... 20 246 537 135 139 50 2, 312 282
ie Olorado._--2-_._.-.....--.- 19 34 100 18 23 16 | Dd ee ol dees
| . Connecticut_._....-..-------- 9 56 88 23 27 18 O26R Baoan cee
IDI GRO. 65655 5S Seen eee Eee 19 18 18 5 les eee 1S | eatin es 2 Re
District of Columbia---._---- 128 41 37 18 11 8 LOOs| Rees
TN OG 5-5 es 277 86 219 44 47 27 951 617
CRORES. a 5S a rs 189 123 310 56 60 33 2, 762 537
GRAYS) 5S 15 16 60 18 138 14 45
ingismesce esa! cole ll 142 216 413 108 121 37 3, 453 531
TOUR oA ec (rT 80 201 52 43 25 2, 438 25
OWE eo 16 38 160 36 41 23 1604" |Seee eee
LGA RE eee 20 43 131 27 31 19 Estep Veal ieee a ee
I RGU HITE Oy a 63 114 260 42 43 24 3, 590 61
Woulsianaee ote =2---s--=~--- 229 86 231 43 42 22 2. Sal |e seece ns
MONG) eee ee 26 75 18 17 Gillean oa ates |e tee
Maryland sss oe. -=2.—2--..-- 56 81 136 33 33 21 C Oi [athe ane
Massachusetts --..------------ 7 132 250 63 71 25 1 962" | eee
Wichivanicesssss.s2.2-2. 522.2 60 133 346 83 75 37 3, OSiy |aeaeeeee =
MinnesOtas =sess+ oe). =-.-..|s--2..-.- 55 190 37 45 22 LO8Gn |Ssse sense
IMississippiecece- foes 23-2. 5 179 90 263 40 48 29 3° 020|eae aaa
1, GIGSSCo) 0) 81 101 251 57 64 29 20S) oneness
19 52 18 13 13 OOH ect ae eens
19 100 14 12 12 O38 |= ete aos
10 30 13 5 8 184 35
INe6éwallampshire._2--......-.|.-=-.-... 14 39 a Ul ea ees ll 206" sve eee
New Jersey__-.-------------- 36 113 245 66 63 29 1, 837 7
New Mexico. --.-------------- 18 32 74 18 14 14 389 217
INGA 6O) Se a 95 367 669 189 203 57 Pe Oi bees hee
North Carolina_..----------- 136 119 370 62 69 28 3, 186 517
INorheDakota:-2..-...--...- 6 28 58 18 14 14 ZA See
Opes eee 62 182 429 108 112 42 6 2625| Stee nee
Oklghoma-c22..22---+s----..< 52 64 176 33 37 19 TOL Re ao sees
(Oyefaoyn a | | 37 109 20 18 9 557 94
iRennsylvaniae---2-——----_-.-- 106 236 585 145 116 54 D415" |2esceeee
inoue pislan Geese onan S- - 55 |<. k 24 42 18 12 4 200s |b aoseae 22
South Carolina_-_----------- 223 86 210 36 39 23 3, 851 1,079
BOUND AKOtase=s- =~ — =... |=-4----_- 19 61 18 10 11 [26 Nsekeecees
Mennesse@s- 2. -- os ---_--- 164 122 281 46 39 yy OHAO4D aera.
ORAS eee eee oe oe wesc ens 221 167 541 116 LOS Ieee eey 4, 726 2
Winlls-=-50 ie 9 12 64 17 11 PAU | bese ou ele
WONT OU tha a 17 35 18 8) 513 Als) Le| eae eee es
WA TaD Reese ee ee 74 116 247 51 52 9 21 3ON Mee eee ee
WASHING OMmreeee ce ee fl ee 52 138 32 27 abr PAL pr eters a. =
West Virginia 222. .-.--..-- 44 56 156 30 32 20 2 SG teas sooses
WWASCOMGHIEe ee ee i ee 49 199 42 36 il¢¢ 1525 | Sever sae.
\WAVO00 1112 == Sa a eee 4 11 38 5 8 5 52822 cere <
PANAS Kates 8s 3 Saas 1 61 602 18 5 10 694 lee aes
[EGU SDL 6 Ae ak ae ae a a 36 35 18 7 13 OO aaecnoe.
EeVWertoen ics... 22-4 --- 92 171 248 34 35 23 SrAVS ieee eecaee
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1 Any discrepancy in total is the result of the rounding process.
2 Includes $940,848.49 in services and supplies furnished in lieu of cash.
3 Includes payment of $564,000 to Alaska for disease and sanitation investigation and control activities.
4 Received less than $1,000. nae
5 Vermont allotment paid to Vermont Heart Association.
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Office of Education
I. Introduction
Tue Basic functions of the Office were defined by Congress in 1867,
' when the Office was established. ‘These functions are:
1. To “collect such statistics and facts as shall show the condition and
progress of education.”
2. To diffuse “such information [on education] as shall aid the people
of the United States in the establishment and maintenance of efficient
school systems,” and
3. “Otherwise [to] promote the cause of education.”
__ These responsibilities are fulfilled in many ways, but basically by
_ studies and research on many aspects, both quantitative and qualita-
tive, of education in America, and, to some small degree, on education
abroad. Findings are made available by or through dozens of major
| publications, by means of conferences and workshops in Washington
and over the country with both professional and citizen groups, by
means of answers to more than half a million inquiries annually, and
through two periodicals—School Life and Higher E'ducation.
The second aspect of the work is that of administering a variety of
| programs for which the Office of Education has become responsible
through the years. For example, the Office budget in 1954 amounted
to $2,911,402 for its basic services ($1,411,042 of which was for ad-
ministration of grants) and $228,213,092 in grants administered. It
administered $197,350,000 in payments to school districts for the con-
struction and operation of schools in what have come to be known as
“federally affected” areas. Likewise, it administered $25,811,591 for
vocational education in local communities and disbursed $5,051,500
_ for colleges of agriculture and mechanic arts.
171
172 Department of Health, Education, and Welfare, 1954
Fo hc UNION NNER lt dale Aeon des ae
In addition, it spent $469,360 administering programs for the
Foreign Operations Administration and the State Department
amounting to $1,929,184.
The Office of Education is guided by the following principles:
First, that the schools are the people’s schools. And by “the people”
is meant all the people: parents, nonparents, teachers, and children.
All have a stake in education and all share in the responsibility for
making the schools the best possible.
Moreover, the Office of Education holds that the schools must be
accessible. Sound practice, responsiveness to the citizenry, and
democracy require this. Schools should not be controlled to perpetuate
any political party, nor any organized group in society—including the
teaching profession—nor any special interest. In effect, the schools
must serve all the people, and they must be responsible to all the people.
In calling the schools “the people’s schools,” it is clear that varying
local, State, and national interests in educational policies, in pro-
cedures, and in organizational methods must recognize and provide
for relating their diverse interests effectively.
For its part, the Office of Education respects the pattern of 48
independent State school systems which delegate much responsibility
and give freedom in operation to local school units. It accepts the
role of the Federal Government as that of assisting and strengthening
the 48 State systems and their local school units with a view to helping
them to carry on their responsibilities without Federal domination,
control, or interference.
A second cardinal principle which guides the Office of Education
is that it should demonstrate belief in democratic process and in educa-
tion as it carries out its responsibilities of national leadership.
It tries to do so by getting the facts and interpreting their signifi-
cance objectively so that they can be understood and put to use by those
responsible for the schools—the American citizenry.
The Office seeks to discharge its national responsibilities also by
administering efficiently the programs for which it is responsible.
It seeks also to present to the people’s representatives—the admin-
istration and the Congress—all the pertinent facts regarding educa-
tion, as well as proposals for strengthening it that are consistent with
the principles which guide it. In a real sense its responsibility is
a teaching one—to study, to interpret, and to ask and to answer
questions.
To strengthen its services to education, the Office, during 1954,
requested, as a part of the administration’s legislative program, and
was granted by Congress, with approval by the President, on July
26, 1954, the following:
A. Funds and authority for educational conferences in each State
and for a White House Conference on Education, to stimulate in-
:
_ Office of Education 173
creased State and local action to meet present and impending
educational needs.
B. Authority to increase educational research. Authority was
granted the Office of Education to engage in cooperative research
with colleges, universities, and State departments of education. Also
an Advisory Committee on Education was authorized to identify
major problems in education needing commission-type studies and
to recommend appropriate action to implement findings of such
studies.
The Office of Education program is shaped in part by congressional
action and at times by decisions of the Supreme Court. It is there-
fore perhaps appropriate to note briefly congressional acts and a
Supreme Court decision in 1954 of special consequence to the Office
of Education and to education in the United States.
Public Law 731, approved August 31, 1954, an amendment to Public
Law 815, 81st Congress, provided for a 2-year extension of the pro-
gram of assistance to school construction in federally affected areas
under title ITI of that act.
Public Law 732, approved August 31, 1954—an amendment to Pub-
lic Law 874, 81st Congress—postponed the effective date of the
3-percent “absorption” requirement for 1 year.
Other items of educational interest include the following: Public
Law 325, approved April 1, 1954, provided for the establishment
of the edad States Air Rone Academy; Public Law 610, approved
| August 20, 1954, extended the period during which certain veterans
educational and training benefits may be offered; Public Law 733,
approved August 31, 1954, authorized the Commander of the Air
| University, under certain conditions, to confer advanced degrees upon
| students in the Resident College of the U. S. Air Force Institute
of Technology; Section 37 of Public Law 591, approved August 16,
| 1954 (Internal Revenue Code of 1954), liberalized taxes on retire-
_ ment income so as to give most retired teachers tax credit of $240
on that income; and Public Law 719, approved August 30, 1954,
| granted the consent of Congress to certain New England States to
enter into a compact relating to higher education and establishing
the New England Board of Higher Education.
The year 1954 was made notable also by action in another area
which has far-reaching implications for America’s schools and col-
leges; namely the decision of the United States Supreme Court in the
school segregation cases. These cases had been argued before the
Court in the 1952 session, but no decision was handed down. They
were, however, restored to the docket for reargument, which took
place in December 1953.
On May 17, 1954, the Court handed down a decision that racial
segregation re the able schools is unconstitutional, on the ground
174 Department of Health, Education, and Welfare, 1954
=n ehh Alege seach
that it deprives the children of a minority group of equal educational
opportunities? Later the cases were again restored to the docket and
the parties were requested to present further argument concerning the
implementation of the Court’s decision by specific decrees. Argument
for this purpose was scheduled by the Court for December 1954.
During fiscal year 1954, three persons served as Commissioner of
Education. The first was Dr. Lee M. Thurston, who became the 12th
U. S. Commissioner on July 2, 1953. He brought to this office experi-
ence as public school teacher, school superintendent, college professor
and head of the State Department of Public Instruction of Michigan.
He conducted the Office program, in the new Department of Health,
Education, and Welfare, with such vigor and understanding that, after
a span of only 2 months, he had won the confidence and support of
colleagues and the profession. .c2 00 ne ee oe lee Le ec ee ee 21 16 0
Cereals and grain products:
MED At MT einen ee ese SO ee ees ee eae 157 5 0
ASR EGA TINS 2) On SiR lp 5 le ge 2 5 0
Chocolate, confectionery, and other sugar products________--__-_---- 43 7 0
Dairy products:
SE Rags ee ec oe bane eeccaeax eee ccceeesess 22 12 rt)
@heesewmnd other dairy products... _.2..22.--22.--22-2--22-2-4- 17 15 0
JELBEES Sigs CEE TEL OCG NENA Ge le ee 20 4 0
Hla vorsaspices «condiments 2- 2. 225.2 sss 52S eb lL e bles. at--2-22- 21 2 0
Bis nb pROGUCtS- 22-2 .2 2 2 5 es sa ec ote se 105 4 0
Wie aimonoomersranG DOUILT yo ses - 2-2 en ds bse eee e dt 40 U4 0
Niele meT OUOOUCUS. .- 2252-2 -.-..2--0--2----~~----~--=---------- 54 6 0
Oils watson e oleomarcarine.....-.........-...--.--.=.------4.++-.- 3 0 1
ae ee RS Se oa a ee | 148 10 0
Weretapiesand: veretable products:.-_-.2.--..--.---.-..---+..-+-- 103 9 )
Miscellaneous foods and food adjuncts___..__-_..--_----------------- 24 2 0
HOoesIOMSMECINUG letATY. USCS.2 2 u4 - oe oe eo ne bs sau. scone 32 1 0
TROP meen VaATorOlOleOMarcarino—- 622 3-2-4 5-- ooo ease ocean [ose soee cee 2 0
Table 2.—Enforcement activities during the fiscal year 1954
Pee Number of | Number of
Item of entoree: establishment samples
vnané tie inspections collected
IMCS ICM ee se ek Ue eee oo acee 90. 2 113, 827 21, 455
UG ( eenntet ne yo ee Sat ees 56. 4 11, 061 11, 227
aeMesiamd devices eso. 2. 52-- 2s) eke ose eset eee 41.1 2, 419 9, 968
Mgorite MeSIanOICOlOrS. = Soo os ee Ss owt detonate 2.1 285 191
Othernacts ang miscellaneous... -22-02- 2.2 22---21--.-..-- 4 62 69
RRR ae ee ee ee ae ee eee 9.8 0 10, 922
tIncludes 10,119 factory inspections and 3,708 warehouse surveys.
220 ; Department of Health, Education, and Welfare, 1954
OEE
Table 3.—Number of samples on which criminal prosecutions and seizures
were based and number of court actions instituted during the fiscal year
1954
Total Criminal prosecu- Seizures accom-
tions instituted plished Injunc-
Item eT a are tions ¢
; Violative ; Violative ; Violative 5 requeste
samples Actions samples Actions samples Actions
Totalct a gas pe 2, 634 1, 333 1, 057 260 1,577 1, 057 16
OOdSs 2 Bee SS ce ee Bs 1, 565 946 338 108 1, 227 836 Be
Drugs and devices_---222=+---=- 1, 065 384 719 152 346 218 14
Cosmetics and colors. ---------- 2 1 0 0 2 al 0
Causticipoisons=4-26-2.=-2 =e e= 2 2 0 0 2 2 0
Table 4.—Import inspections and detentions during the fiscal year 1954
Inspected th
: spected
Item Total eer Sa and released
Total sateen Lele ae Pea Ce See eee ee es 25, 105 4, 459 20, 646
OO CS eee ee ee ee eee 21, 936 3, 154 18, 782
Drugs and devices ........2--- -22---2is—S3Sh 2 oh 4e-b seve en sab = 3, 007 1,271 1, 736
Cosmetics, colors, and miscellaneous---------------------------- 162 34 128
Office of
Vocational Rehabilitation
A New Era in Rehabilitation
The close of fiscal year 1954 marked the dawn of a new era in voca-
tional rehabilitation. As the year drew to an end, the Congress was
in the final stages of considering a sweeping new law to carry out the
President’s recommendations for a greatly improved program to
restore disabled people to productive work. The Vocational Rehabil-
itation Amendments of 1954, passed unanimously by both Houses of
the Congress, were signed into law on August 3, 1954. Other legisla-
tion of vital concern to the rehabilitation program had been approved
on July 12 when the Medical Facilities Survey and Construction Act
of 1954 became law.
Against the year’s backdrop of extensive preparation for strength-
ening public services for the disabled, the State-Federal program
rehabilitated nearly 56,000 disabled men and women. Most of these
individuals are now regularly employed with incomes adequate for
self-support. An estimated 11,000 of them were receiving public
assistance either at the time of acceptance for services or during their
rehabilitation. State agencies for vocational rehabilitation reported
that greater emphasis on serving the severely disabled, together with
higher costs of medical and other services purchased for those who
were rehabilitated, account for the decline of 9 percent from last year’s
total of 61,000 in the number restored to useful work.
The immediate goal set by the President for the State-Federal
vocational rehabilitation program calls for a progressive expansion
of services over the next 5 years. The ultimate aim is to rehabilitate
those persons who, by reason of illness, injury, or congenital causes,
come to need vocational rehabilitation each year. Many thousands
of handicapped persons will be brought to the attention of State voca-
221
222 Department of Health, Education, and Welfare, 1954
ee
tional rehabilitation agencies as a byproduct of the operation of the
1954 Social Security Act amendment to preserve the rights to old-age
and survivors insurance benefits during disability. Achievement of
the goals contemplated in the new legislation will require greatly
increased financial support for the program by the Federal Govern-
ment and by the States.
THE NEW VOCATIONAL REHABILITATION LAW
The Vocational Rehabilitation Amendments of 1954 provide for
continuation of the existing State-Federal program, with certain basic
changes and additions which are summarized under the headings
which follow.
New Grant System
The act provides for a three-part grant structure consisting of
grants for the support of basic vocational rehabilitation services,
grants for extension and improvement of these services, and grants
for special projects.
Support grants will be allotted to the States on the basis of popu-
lation weighted by per capita income. The law provides for maximum
and minimum allotments through an allotment formula similar to
that embodied in the Medical Facilities Survey and Construction Act,
which authorizes Federal aid for the construction of hospitals, reha-
bilitation facilities, and other medical facilities. Application of the
formula will result in establishing both a minimum and maximum
increase in Federal funds each year to all States as compared with
1954, provided that the Federal appropriation for support grants
each year exceeds $23 million.
Hatension and improvement grants will be allotted to the States on
the basis of population, with provision for a minimum allotment of
$5,000 or such other sum as the Congress may specify in making appro-
priations. This type of grant will comprise funds to be used for
extending and improving rehabilitation services incorporated in the
State plan. A Federal share of 75 percent is authorized for each
State, limited to 3 years for any one project.
Special project grants include:
(1) Grants to States and public or other nonprofit organizations
and agencies for paying part of the cost of projects for research,
demonstrations, training and traineeships, and projects for the estab-
lishment of special facilities and services which hold promise of
making a substantial contribution to the solution of problems in voca-
tional rehabilitation that are common to several States.
(2) Grants for 1955 and 1956 to aid in a substantial nationwide
expansion of rehabilitation programs in the States. Public Law 565
does not specify any rate at which grant recipients must match
Office of Vocational Rehabilitation 223
Federal funds, but appropriation language, subsequently enacted,
does require that the Federal share of a grant not exceed two-thirds
of the total.
Those States which have separate agencies serving the blind are
given complete latitude in dividing the allotments between the agencies
serving the blind and those serving the sighted disabled, except for
that portion of their support grants which constitute their base allot-
ments. ‘This will be divided as the 1954 allotment was divided. Sepa-
rate Federal shares for matching the base allotment will be used
until the new matching provisions are fully in force in 1963.
The amounts authorized for grants in the law are $30 million for
1955, $45 million for 1956, $55 million for 1957, $65 million for 1958,
and such sums as the Congress may determine for each succeeding year.
The amount for each type of grant is to be specified in the annual
appropriation act, except that the first $23 million of the aggregate
appropriation will be reserved for basic support grants.
Expansion of Types of Services
The new law continues the entire range of rehabilitation services
now authorized (see p. 227), and provides for some services that
are new. The new features include authority for Federal participa-
tion in expanding, remodelling, or altering existing buildings to render
them suitable for use as public or nonprofit facilities for rehabilitation
of the severely disabled, or for sheltered workshops for training and
employment of the severely disabled. Under the new law, Federal
funds may be used to provide initial equipment and—in the case of re-
habilitation facilities—to provide the staff during the first year of
operation. This feature of the new law will supplement provisions
for construction of rehabilitation facilities under the Medical Facili- |
ties Survey and Construction Act of 1954.
Training Professional Personnel |
The shortage of trained personnel to work with the disabled con-
stitutes one of the most serious problems in rehabilitation. To meet
this problem, the new law authorizes Federal participation in the
training of professional personnel in the varied specialized skills
demanded in this field. Specific provision has been made for teaching
grants and traineeships.
State and Local Administration
The law relaxes previvus requirements that responsibility for ad-
ministering the program must be borne by State boards of vocational
education. Henceforth, the States may, at their own option, either
continue their rehabilitation programs under their boards of voca-
tional education or place them under separate agencies concerned
primarily with rehabilitation.
224 Department of Health, Education, and Welfare, 1954
In each State which has a separate agency serving the blind, this
agency henceforth may function as the sole State agency responsible
for administering that part of the State plan relating to rehabilitation
of the blind. |
Further flexibility is provided under the new law in authority for
the States to decentralize administration of their rehabilitation pro-
grams to county, municipal, or other governmental agencies. When
such decentralization is effected, however, supervision will be exercised
by the State agency for vocational rehabilitation.
Coordination Among Public Agencies
The new law encourages strong cooperative relationships between
State agencies for vocational rehabilitation and all other agencies—
such as public employment services—which provide services needed
in the vocational rehabilitation and job placement processes. |
Within the Federal Government, coordinated planning is a require-
ment of the new law. The Secretary of Labor and the Secretary of
Health, Education, and Welfare are directed to develop and recom-
mend to appropriate State agencies policies and procedures which will
promote the employment of disabled men and women who have re-
ceived services under the rehabilitation program. In addition, the
Secretaries of these two Departments are directed to work with the
Chairman of the President’s Committee on Employment of the Physi-
cally Handicapped in developing methods to secure the maximum use
of services of the Committee and its cooperating State and local
organizations in promoting employment opportunities for the
disabled.
Federal Administration
The new law continues, with even greater emphasis, the responsi-
bilities of the Department of Health, Education, and Welfare for the
exercise of leadership in the rehabilitation program. The Department
is required to make studies, investigations, demonstrations, and reports
on various aspects of the needs and abilities of handicapped people;
to conduct demonstrations of new rehabilitation techniques and
methods; to provide technical assistance to the States; to disseminate
public information regarding the program; and otherwise to promote
the cause of rehabilitation and employment of disabled people.
Amendments to the Randolph-Sheppard Act
The new legislation also strengthens the program of licensing the
blind to operate vending stands in Federal buildings. Amendments
to the Randolph-Sheppard Act of 1936 extend provisions of that act
Office of Vocational Rehabilitation | 225
to Federal property as well as Federal buildings, and give preference
for the establishment of vending stands to licensed blind vending-stand
operators. These amendments require heads of Federal agencies in
control of Federal property, after consultation with the Secretary of
Health, Education, and Welfare and with the approval of the Presi-
dent, to prescribe regulations designed to assure such preference. The
assignment of income from vending machines also must be made in a
manner to achieve and protect this preference.
HIGHLIGHTS OF 1954
Total expenditures for the public rehabilitation program during
1954 amounted to $35.4 million. Of this sum, $23 million was supplied
by the Federal Government, and $12.4 million came from State and
local sources.
It is estimated that the disabled persons rehabilitated for gainful
work during the year are now paying Federal income taxes on their
earnings at a rate of $8.5 million a year. Thus, in less than 3 years
they may repay the equivalent of the entire Federal investment in the
program during 1954.
The cost of operating the program during 1954 amounted to $634
per individual rehabilitated.
Of the 55,825 disabled men and women restored to productive work
during the year, 6,500 had substantial visual defects, including 3,300
who were blind.
At the close of the year, 126,770 disabled men and women were re-
ceiving services from the 88 State agencies for vocational rehabil-
itation.
_ About 3,000 of the men and women rehabilitated during the year
entered professional fields such as education, medicine, and engineer-
ing. More than 7,000 of them are in the skilled trades, and about 5,200
are employed in agriculture.
The Nation has gained another 86 million man-hours « year of pro-
ductive effort through the restoration of this year’s group of disabled
men and women to gainful employment.
The disabled people who were rehabilitated during the year in-
creased their combined annual earnings from an estimated $15 million
prior to their rehabilitation to an annual rate of $102 million after
their placement in jobs.
More than 41 percent of the $21.2 million used for the purchase
of services for disabled beneficiaries of the program during the year
was spent for medical services, which included examinations, treat-
ment, hospital and convalescent care, and prosthetic appliances.
226 Department of Health, Education, and Welfare, 1954
Facilities and Services for the Disabled
THE STATE-FEDERAL PARTNERSHIP
Ever since the implementation of the first Vocational Rehabilita-
tion Act in 1920, public services designed to preserve or restore the
ability of disabled people to work have been provided by a partner-
ship of the Federal Government with the States. Today vocational
rehabilitation services are provided by all of the States and Terri-
tories except the Virgin Islands. In 35 of the States and in Hawaii,
separate agencies serve the blind. There are 88 State agencies (in-
cluding those in the Territories and the District of Columbia) which
work in this field in conjunction with the Office of Vocational
Rehabilitation.
Each public agency for vocational rehabilitation operates its pro-
gram in accordance with a State plan that is designed to meet as fully
as possible the needs of the States, and to conform with Federal laws.
The Office of Vocational Rehabilitation assists the States in develop-
ing and improving their plans, and in providing services to the dis-
abled in conformity with these plans.
The Vocational Rehabilitation Act Amendments of 1943 provided
that Federal grants-in-aid made to the States for vocational rehabilita-
tion would cover all of the necessary costs of administration, counsel-
ing, and placement, and half the costs of other services provided to
disabled people. The result of this legislation was to increase substan-
tially the Federal share of the cost of the program. By 1953, the
Federal share had leveled off at about two-thirds.
The law did not control the Federal proportion of the costs of the
program, and provided for no specific limitations upon the Federal
obligation. Federal expenditures were conditioned upon State ex-
penditures. The Federal appropriations thus were “open end” ap-
propriations, and the funds appropriated by the Congress for
rehabilitation in a given year were used in part to pay Federal
obligations predicated upon State expenditures during the preceding
year.
Beginning with the 1948 fiscal year, Federal funds appropriated
for rehabilitation during any 1 year have not been sufficient to meet
the Federal share of State expenditures defined as reimbursable by
law. This had the effect of imposing a limit on the amount of
Federal funds which could be granted to the States without lessening
Federal obligations under the act.
To correct this situation, appropriation language enacted during
1954 in effect closed the open-end feature of Federal appropriations
for vocational rehabilitation. The provisions under which the pro-
gram operated during the fiscal year limited the obligation of the
Office of Vocational Rehabilitation 227
Federal Government to any State for that year to an amount which
did not exceed the amount of Federal funds apportioned to the State
for vocational rehabilitation. In this way a legal limitation was set
upon Federal expenditures for this purpose apart from the previous ~
limitation based only on State expenditures. The new Vocational
Rehabilitation Act of 1954, described above, incorporates the concept
of closed end appropriation on the part of the Federal Government
and thus provides for sound fiscal policies and management.
SPECIFIC SERVICES FOR THE DISABLED
The services of vocational rehabilitation are designed for one major
purpose—to preserve, develop, or restore the ability of disabled men
and women to perform useful work. Each disabled person served by
the program is provided with the combination of services which meets
his or her individual need, in accordance with a rehabilitation plan
worked out by the State agency.
Of the services that follow, those numbered 1, 2, 8, and 9 are fur-
nished without cost to the disabled individual. Training (item 5)
generally is furnished without cost. Public funds are used for the
others to the extent that the individual is unable to pay for them.
The nine services are:
(1) Medical diagnostic services to learn the nature and degree of
disability and to help determine eligibility for services, the need for
additional medical services, and the individual’s work capacities;
(2) individual counsel and guidance, including psychological testing,
to help select and attain the vocational objective; (3) medical, surgi-
cal, psychiatric, and hospital services to remove or reduce the dis-
ability ; (4) artificial limbs and other prosthetic appliances; (5) train-
ing, including occupational training and adjustment training for the
blind; (6) maintenance and transportation during treatment or train-
ing; (7) tools, equipment, or licenses if these are necessary to give the
individual a fair start; (8) placement in a job commensurate with
the individual’s highest physical and mental capacities; (9) follow-up
to insure that the rehabilitated person is successful and that both he
and the employer are satisfied.
PHYSICAL RESTORATION
The physical restoration of the disabled, which has been a service
of the vocational rehabilitation program since 1948, continues to
absorb a substantial proportion of the rehabilitation dollar. More
than 100,000 disabled individuals served by the program received
medical examinations for diagnosis and determination of eligibility.
Many of these individuals also received other medical attention. The
total expenditures during 1954 for medical services and examinations
amounted to $8,696,010.
228 Department of Health, Education, and Welfare, 1954
IN a re mo
In recent years, increasing emphasis has been placed upon the
rehabilitation of the more severely disabled. Striking evidence of
the fact that State agencies for vocational rehabilitation are serving
persons with more serious disabilities than in the past is revealed
by a comparison of the numbers hospitalized and the cost of their
hospitalization during 1954 with corresponding figures for 1949. In
the latter year, 18,031 persons were furnished with hospital and
convalescent care at a total cost of $1,832,494. During the 1954 fiscal
year, 15,411 persons were furnished with these services at a total cost
of $2,886,842.
It should be borne in mind that expenditures for physical restora-
tion by State agencies represented only a portion of the total cost of
this type of services to clients of the vocational rehabilitation program.
In many instances, the clients themselves were able to bear a portion
of the cost of medical services. In other cases, all or part of the costs
were borne by other public or voluntary agencies.
To promote the best possible medical services within the rehabilita-
tion program and at the same time to assure the best use of funds spent
for this purpose, the Office of Vocational Rehabilitation and asso-
ciated State agencies benefited from consultation and guidance from .
some of the Nation’s leading medical authorities.
The Office of Vocational Rehabilitation this year became an Ad-
visory Member of the National Health Council, and participated in
the National Health Forum considering problem of peteenget
shortage in the health field.
Progress in Meeting Unsolved Problems
There are many unsolved problems in vocational rehabilitation that
relate to specific categories of disability. Some of these problems are
largely medical; some are primarily vocational; still others are essen-
tially psychological. How can epilepsy be controlled more effec-
tively? What must be done to win vocational acceptance for the
cerebral palsied? How can we more surely prevent emotional dis-
turbance arising from the realities of severe physical disablement?
Perhaps complete solutions never will be found. But as medical
science advances, and as the combination of experience and research
in the social sciences leads to better techniques in the physical restora-
tion of the disabled, improvement is achieved. Progress comes from
multipronged attacks launched in several sciences against common
problems.
Nowhere is this more evident than in the establishment of work
classification units for evaluating as scientifically as possible the work
capacity of persons with heart disease. By bringing together a basic
team consisting of a physician, a social worker, and a vocational coun-
Office of Vocational Rehabilitation 229
selor, these units exemplify the team approach to the problems of
disability.
Work classification units in this country increased from only 8 in
1952 to about 30 in mid-1954. This increase is important to
the efforts of State agencies for vocational rehabilitation in meeting
the needs of clients disabled by heart disease. One factor in the in-
crease was the 1952 agreement between the American Heart Associa-
tion, the Public Health Service, the U. S. Employment Service, and
the Office of Vocational Rehabilitation. Local affiliates of the Ameri-
can Heart Association have assumed major responsibility for organiz-
ing work classification units.
In another problem area—that of mental or nervous system dis-
ability—State rehabilitation agencies continued their emphasis upon
expanding their services. Approximately 3,800 individuals in this
category were restored to useful and productive lives during the fiscal
year.
In spite of the growing interest on the part of State agencies in the
possibilities offered by intensive work with persons who have psychiat-
ric disabilities, small inroads have as yet been made against the prob-
lem. Urgent needs of State agencies to meet the challenge posed by
this category of disability are now widely recognized. 'These include
specially trained personnel who can assume responsibility for the
work, and consulting psychiatrists readily available to all State re-
habilitation agencies. There is also a great need for more research,
and for a more far-reaching program of information and education
directed toward the general public, employers, and physicians.
Rehabilitation Centers
Louisville, Miami, Grand Rapids, Akron, Philadelphia, Chicago,
Ann Arbor, and Detroit joined the growing list of communities in
which the integrated facilities of comprehensive rehabilitation centers
are available for meeting the extensive requirements of the severely
disabled. Most of these centers, like many of them which have been
operating in the past, will be used as regional facilities serving severely
disabled drawn from wide geographic areas.
Other communities—such as Orlando, Knoxville, and Savannah—
have begun planning for rehabilitation centers. Still others, along
with several universities, have undertaken studies looking toward the
eventual establishment of rehabilitation centers. This group includes
Oakland, Mobile, and Tacoma. Surveys are underway at Leland
Stanford University, the University of North Carolina, the University
of South Carolina, Western Reserve University, and the University
of Washington.
Obstacles relating to financing, staffing, and similar requirements
must be overcome before a center can be established. This accounts
230 Department of Health, Education, and Welfare, 1954
I st a a a a a ee hl er pee tm
for the relatively few rehabilitation centers added each year despite
the growing interest in them and the recognition of their worth. ‘The —
Office of Vocational Rehabilitation has furnished extensive help to
State vocational rehabilitation agencies, medical schools, and commu-
nity leaders in solving practical problems encountered in the planning
of rehabilitation facilities. ‘Techniques and practices in this rapidly
developing field have been widely publicized by this Office through
professional media. Close cooperation with the National Conference
of Rehabilitation Centers has made it possible for this Office to collect
information on the experience of many centers in all parts of the coun-
try, and to make this experience available to all who are concerned
with operating or planning rehabilitation centers. —
An encouraging trend is evident in the expansion of facilities and
capacity among well established centers. The Kessler Institute for
Rehabilitation, the St. Paul Rehabilitation Center, the Delaware
Curative Workshop, and the Georgia Warm Springs Foundation are
examples. Universities with medical schools are showing increasing
interest in the establishment of rehabilitation centers as part of their
programs. Development of rehabilitation facilities in teaching insti-
tutions ultimately will help solve the critical shortage of trained per-
sonnel—physicians, physical therapists, occupational therapists, voca-
tional counselors, psychologists, social workers, and prevocational in-
structors—which at present is a great barrier to the creation of the
rehabilitation centers that are needed.
Rehabilitation centers for the blind continue to be needed in almost
every part of the country. Only one new such center was established
this year, located in New England. ‘Two well-established centers, the
Rehabilitation Center for the Adult Blind in Topeka and the Re-
habilitation Center for the Blind in North Carolina, have found it — |
necessary to expand their facilities. Very large areas of the country,
particularly in the Western States, still have no rehabilitation centers
for the blind available for use by State rehabilitation agencies.
It is estimated that up to 20 percent of the disabled persons to be
served under the expanded rehabilitation program could benefit from
the services rendered in rehabilitation centers. In addition, many
disabled children and elderly persons need such services but will not
be served directly by State vocational rehabilitation agencies because
they are not within the age brackets of employment.
Services to the States
STRENGTHENING THE PROGRAM
In large measure, the quality of the services provided to disabled
beneficiaries of the public rehabilitation program is conditioned upon
Office of Vocational Rehabilitation 231
the professional skill of staff members and consultants of the State
agencies. While many of the techniques of rehabilitation are well
established, others are subject to dynamic changes which characterize
progress in such areas as physical restoration and psychological
services. In such a program, it is natural that staff development is a
function of paramount importance. It is also natural that the Office
of Vocational Rehabilitation, charged with the responsibility of fur-
nishing leadership for the program, should take a leading part in
this effort.
Continuing a series that was begun in 1952, four 1-week courses in
“Rehabilitation Practice” were sponsored by the Office of Vocational
Rehabilitation at the Institute of Physical Medicine and Rehabilita-
tion, New York University-Bellevue Medical Center in New York
City. Forty physicians and 28 other professional workers in rehabil-
itation from all parts of the country attended these courses.
To increase understanding of possibilities for rehabilitation of indi-
viduals with mental illness or emotional disturbance, three 1-week
mental health workshops were held for counselors at San Jose Teach-
ers College in California, at the Menninger Foundation in Kansas,
and at Columbia University in New York. These courses, consti-
tuting a follow-up of the series inaugurated in 1953, were sponsored
jointly by the Office of Vocational Rehabilitation and the National
‘Institute of Mental Health.
This Office works closely and constantly with State rehabilitation
agencies for increasing the effectiveness of case work supervision in
_the program, and improving standards and procedures for counseling
the disabled and placing them in employment. The Seventh Annual
Guidance, Training, and Placement Workshop held in Washington
was one undertaking to assist State agencies in this field. Thirty-four
State rehabilitation agencies, including agencies serving the blind,
participated by sending staff members. Regional sessions designed to
‘improve supervision were attended by more than 150 State and
regional supervisors in the rehabilitation program.
To improve the highly specialized services necessary for the rehabil-
itation of the blind, 45 counselors from 11 State agencies received
intensive training conducted by this Office on a decentralized basis
in 3 regions. In cooperation with the American Foundation for the
Blind and the National Industries for the Blind, the Office of Voca-
tional Rehabilitation conducted a workshop on industrial homework
to seek better solutions to some of the problems in this area. This
workshop was attended by 30 individuals from State rehabilitation
agencies and from public and private agencies interested in develop-
ing more effective ways in providing employment to disabled persons
who must remain in their homes. Its consultants included repre-
sentatives from labor and industry.
232 Department of Health, Education, and Welfare, 1954
For the first time, a State agency—the Illinois Division of Voca-
tional Rehabilitation—assumed full responsibility for organizing and
conducting its own in-service training program for counselors for the
blind. A member of the staff of this Office served as coordinator for
this training program.
In addition to formal in-service training activities, the Office of
Vocational Rehabilitation provided extensive consultation to State
rehabilitation agencies in such specialized areas as physical restora-
tion, services for the blind, services for the deaf and hard of hearing,
and determination of eligibility.
To insure adequate dissemination of doctrines and useful specialized
information, the Office of Vocational Rehabilitation published and —
distributed a variety of technical materials designed to aid rehabili-
tation personnel both in the public program and in cooperating volun-
tary and private agencies. Two of those are particularly significant.
The technical bulletin, “Counselling for Psychological Acceptance
of Disability,” is a companion piece to an earlier work entitled “Psy-
chological Aspects of Physical Disability” published by this Office
last year. The new publication is being used widely both within the
State-Federal program and by workers in voluntary organizations.
The “Counselors Guide, How To Analyze the Rehabilitation Needs
of Blind Persons on the Farm,” was revised and reissued in printed
form. This publication, designed to assist counselors in making satis-
factory placements of blind persons in agricultural work, has had
wide circulation and use by public and private agencies concerned with
the rehabilitation and employment of the blind.
Important help to State rehabilitation agencies in developing more
accurate and effective standards for measuring the financial ability of
disabled clients to pay for the cost of their rehabilitation was provided
during the year. This area is technical and difficult; standards which
are equitable and which take into account wide differences in indi-
vidual circumstances are needed, and practices must be revised from
time to time in order to reflect changing costs. A number of State
agencies have adopted recommendations of this Office for revising
economic need standards for the disabled individuals they serve.
STIMULATING EMPLOYMENT OF THE HANDICAPPED
Despite the advancement of a more enlightened public attitude to-
ward the handicapped, resistance still is encountered among employers
by the rehabilitation counselors and employment service specialists
who must find jobs for men and women with impairments. This re-
sistance stems primarily from lack of understanding of the capabilities
of the disabled when properly prepared for employment and selec-
Office of Vocational Rehabilitation 233
tively placed. To overcome it, the Office of Vocational Rehabilitation
is working with the President’s Committee on Employment of the
Physically Handicapped, the Department of Labor’s Bureau of Em-
ployment Security, and the Veterans’ Administration in a continuing
joint program of public information. 3
This program reaches its peak during National Employ the Physi-
cally Handicapped Week in October, with the release of carefully
compiled informational materials timed for wide use by all media of
communications during the week’s observance. The Office of Voca-
tional Rehabilitation prepares suitable materials for use in periodicals
and over the air, and also furnishes materials to State rehabilitation
agencies for adaptation and use locally.
To encourage employment of qualified handicapped workers in pub-
lic service, this Office proposed the establishment by the President’s
Committee on Employment of the Physically Handicapped an annual
award to public personnel officials who make outstanding contributions
to the promotion of job opportunities for the handicapped. This
award was incorporated in the program of the President’s Committee.
Working through the U. S. Civil Service Commission, this Office
provided specific information designed to encourage the employment
of handicapped individuals—particularly those with hearing loss and
_ cardiac conditions—to Federal appointing officials throughout the
country. Technical assistance also was furnished to the Civil Service
Commission in the validation of tests designed for use in determining
the qualifications of blind persons for employment in Federal civil
service positions.
The Office of Vocational Rehabilitation in cooperation with some
of the State rehabilitation agencies has focused the attention of the
hospital industry on the possibilities of employing selectively placed
disabled persons as a means of overcoming acute personnel shortages.
Information on availability and use of handicapped workers has been
furnished to the entire industry, and assistance has been provided to
individual hospitals with specific personnel problems in this area. In
cooperation with the United Mine Workers Welfare and Retirement
Fund, three State rehabilitation agencies are developing a recruit-
ment and training program to supply qualified disabled hospital work-
ers for the chain of hospitals now being built by the United Mine
Workers of America in Virginia, West Virginia, and Kentucky.
The Vending Stand Pregram for the Blind
The upward trend of gross sales and net profits accruing from the
operation of vending stands for the blind continued into 1954 with
establishment of another all-time record. The number of vending
stands operated under the terms of the Randolph-Sheppard Act for
339010—55——_16
234 Department of Health, Education, and Welfare, 1954
at as a na AL Rare es
the benefit of the blind increased from 1,581 to 1,599 during the year.
Gross sales increased from $20.6 million to nearly $22 million, pro-
ducing net earnings for 1,659 blind operators amounting to more than
$3.6 million. )
In addition to furnishing a living for the blind men and women who
operate these vending stands, the program provided a livelihood for
272 blind employees and 629 sighted assistants, making totals of 1,931
blind persons and 2,560 persons in all.
The following table presents detailed figures on the vending stand
program, and indicates steady progress in the 3-year period during
which these detailed records have been kept.
Totals for Vending Stand Program for the Blind, Fiscal Year 1954
Number of vending stands in Federal buildings__________-_______ dis
Number of vending stands in non-Federal buildings_____________-_ 1, 026
Total number ‘of. ‘vending ‘standsiul ie els elo eee ae 1, 599
Number of operators employed in Federal buildings_______-______ 591
Number of operators employed in non-Federal buildings__. _-_____~_ 1, 068
Total. number. of. operators. employed.2.. ee one oe eee 1, 659
Number blind assistants employed___...._.-___-_..___- See 272
Number sighted assistants employed.s_l—"~____2_ =) 2 eee 629
Total: number: employed esau: Se Seles ee 2, 560
Neét earnings. of! operators only. so.0 ces eeec ue ee ee $3, 638, 047
Net earnings of operators and all assistants____________________ $4, 766, 988
GOSS) SAIC og i tee epee em a ee a ce $21, 972, 549
Money ‘value Of program uo oo $2, 903, 473
Cost’ of management’ services. 2. Ie eee $855, 422
Amount of administrative fees collected by agencies for providing
management, services. wee ace Ao Ae Si ee ee ee $634, 199
Actual cost to State agencies in operating the program___________ $221, 223
Number of persons employed in providing supervisory services to
the operators:
Pull Cimese hot eee eee eee ee ee elle 149
Part timedivm heed en ae Jn nae bo i ee 69
Total average net income to operators located in Federal buildings__ $2, 531
Total average net income to operators located in non-Federal
ulbding se ee oe a aa el $2, 006
The average net income for all operators in all locations_________-_ $2, 193
Facts and Figures About Rehabilitants
CHARACTERISTICS OF THE PERSONS REHABILITATED
Virtually every type of physical impairment is found among the
disabled men and women rehabilitated through services of the State-
Federal rehabilitation program. Chart 1 shows the distribution of
the persons rehabilitated during 1954 among eight broad categories of
disability.
235
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236 Department of Health, Education, and Welfare, 1954
Ec ee ect avinhcrdrbe dint Ape enetbsecriti Aihara I
Of these, amputation and impairment together make up the ortho-
pedically disabled, accounting for 41 percent of the total. About two-
fifths of the persons with orthopedic disabilities were injured in
accidents, and about one-fifth became disabled as a result of polio-
myelitis, arthritis, or osteomyelitis.
Chart 1 also shows the distribution of the 1954 rehabilitants among
major vocational fields. There is no significant change in this dis-
tribution over the preceding fiscal year.
More than three-fourths of those rehabilitated during the year were
unemployed at the time they were accepted for services; 18 percent of
the total group had never worked. About half of those rehabilitated
were dependent on their families for their major support and, as
pointed out earlier, an estimated one-fifth were receiving public as-
sistance at the time of acceptance or during their rehabilitation.
Nearly half had dependents, and 63 percent of those rehabilitated were
men. The average age at the time of disablement was 24; the average
age at the time services were begun was 84.
Physicians, health agencies, and hospitals continued to be the most
important sources of referrals, together accounting for 33 percent of
those rehabilitated during 1954. Public welfare agencies constituted
another major source; 14 percent of those rehabilitated during the year
were referred by these agencies. (An earlier study indicated that 20
percent of all new referrals, as distinguished from persons rehabili-
tated, were from public welfare agencies.) Eleven percent of this
year’s rehabilitants sought help of their own volition, and 7 percent
were referred by State Employment Service offices.
All of the rehabilitants received counseling and guidance, and most
of them were placed in gainful employment through services of the
rehabilitation program. Forty-three percent of them were provided
with physical restoration, and 31 percent were given training. Ten
percent received both physical restoration and training.
Many times in the past this question has been asked: Do the majority
of disabled individuals restored to useful work through this program
actually “stay rehabilitated ?”
The publication of a year-long study made by a member of the
faculty of the University of Washington Graduate School of Social
Work with the cooperation of the Washington Division of Vocational
Rehabilitation provides an answer. While this study applies to a
specific group of rehabilitants in the State of Washington, it is signifi-
cant nationally because its findings are believed to reflect a pattern
that 1s common throughout the program.
The 321 persons included in the study had been rehabilitated in
fiscal year 1951, and their employment histories since closure of their
cases were ascertained during the Autumn of 1953. Ninety-two per-
Office of Vocational Rehabilitation 237
ai i alates id Me Baral ei lk LS Ew
cent were found to be self-supporting as wage earners, or fulfilling the
responsibilities of housewives. Whereas 53 percent had been receiving
public assistance at the time they were accepted for rehabilitation or
had been referred by welfare departments, only 3 percent were depend-
ent on public assistance at the time of followup.
THEY PROVE THAT REHABILITATION PAYS
Careful study of the need for vocational rehabilitation, coupled
with the high returns paid on this investment of public funds, con-
vinced committees of the House and Senate that increased support of
the nationwide rehabilitation program could be justified even as an
economy measure.
Since an estimated 11,000 of the rehabilitants (during 1954) were
receiving some form of public assistance at the time they were ac-
cepted for services or at some time during their rehabilitation, and
since more than 42,000 of the 55,825 rehabilitants were not employed
when their rehabilitation began, Federal income taxes paid by the
group could be assumed to be very small. But on their present esti-
mated annual earnings, as pointed out earlier, they are paying Federal
income taxes at an estimated rate of $8.5 million a year. It is esti-
mated that, during their working lives, they will pay in Federal
income taxes $10 for every Federal dollar invested in their re-
habilitation.
Federal tax revenues are by no means the only financial benefits
which accrue from rehabilitation. The increased purchasing power
of nearly 56,000 of our people—many of them family heads—will re-
sult in higher tax revenues to State and local jurisdictions as well.
Moreover, these tax revenues will continue year after year, whereas
the cost of rehabilitating the disabled is generally a one-time
expenditure. |
Studies indicate that, in a substantial portion of the families receiv-
ing public assistance, physical disability of the breadwinner is a major
cause of the need for aid. Experience is showing that some of these
families can be returned to a status of economic independence through
rehabilitation services which restore the earning power of the wage
earner. The $634 program cost for each individual rehabilitated in
1954 is actually less than the cost of maintaining a family on public
assistance for even 1 year.
Help for Other Nations
Vocational rehabilitation was a major item on the agenda of the
International Labor Organization’s 37th conference at Geneva, and
the Office of Vocational Rehabilitation had primary responsibility for
238 Department of Health, Education, and Welfare, 1954
ccc eR se eich int reece ean Ati SE
developing the United States response to requests for information in
this field which were the basis for conference discussions. The United —
States delegation, which included the assistant director of this Office,
was successful in having its preamble unanimously adopted by the
conference.
The fact that rehabilitation of the disabled can be a constructive
force in economic as well as social development has gained wide ac-
ceptance. This is evidenced by the increased number of requests
from countries for assistance in this field under the Foreign Opera-
tions Administration and the United Nations Technical Assistance
programs for economic development. The Office carried responsi-
bility for programs of observation and study in this country for
nearly 100 persons.
This Office continued its activities in development of materials on
rehabilitation for use of the Department of State in its work with the
United Nations Secretariat, the Economic and Social Council, and
the Social Commission.
The Republic of the Philippines enacted legislation to establish
a program for vocational rehabilitation patterned roughly after our
own. Key personnel from the Philippines had received orientation
in the United States under the auspices of the Office of Vocational
Rehabilitation. In Brazil, considerable progress was reported for
the program inaugurated some time ago in that country with the help
of the Director of Vocational Rehabilitation from West Virginia,
who served as a consultant for this Office. Technical help to the
United States consultant in rehabilitation in Mexico, who was recruited
by this Office, is being continued. |
The District of Columbia Rehabilitation Service
The fiscal year ended June 30, 1954, was the last year in which
the District of Columbia Rehabilitation Service operated as a part
of the Office of Vocational Rehabilitation. Under the terms of the
new Vocational Rehabilitation Act, this agency has been transferred
to the District government.
During 1954 the Rehabilitation Service restored 284 disabled men
and women to gainful employment. Approximately 1,000 new appli-
cations for service were received during the year, and there were
837 persons in process of rehabilitation at the year’s end.
Prior to their rehabilitation, the 284 disabled men and women pre-
pared for work and placed in jobs during 1954 were earning at an
aggregate rate of less than $41,000 a year. After their rehabilitation,
their combined earnings were estimated at more than $644,000 a year.
Under the provisions of the Randolph-Sheppard Act, the District —
Office of Vocational Rehabilitation 239
of Columbia Rehabilitation Service (as the authorized licensing
agency) supervises 58 vending stands operated by blind men and
women in Federal buildings. These vending stands, providing employ-
ment for 65 individuals, did a gross business of $1,871,892 during the
year. Earnings of the operators and their employees totaled $302,698.
The operators and their assistants are paying Federal income taxes
at an estimated rate of more than $35,000 a year, and are paying
District and other taxes amounting to about $5,000 a year.
The development of a psychological testing program, as an aid to
improving the quality of rehabilitation, exemplifies the heavy em-
phasis which is being placed on improving services to the disabled.
This program enables counselors to gain a better insight into the
- Interest, aptitudes, and achievement and personality patterns of their
disabled clients. A total of 829 psychological tests were administered
during the period.
The Rehabilitation Service maintains counselors with the staffs
of two public treatment facilities in order to ensure prompt help
where this is needed. At the District of Columbia General Hospital,
the counselor is a member of the Medical Evaluation Clinic. This
makes it possible for him to participate in medical evaluations which
uncover potential rehabilitation cases.
At St. Elizabeths Hospital, the rehabilitation counselor took a lead-
ing part in the return of 31 clients with mental illness to normal com-
munity life. The continued hospitalization of these patients would
have cost more than $55,000 a year.
240 Department of Health, Education, and Welfare, 1954
Table 1.—Number of referrals and cases, by agency, fiscal year 1954
[Corrected to September 15, 1954]
Referrals Cases a
During fiscal year During fiscal year
Re- ae Closed from active load Re-
Agency ! main- ota Elis te main-
eer Ac- Not ing active ing
cepted eepted(2" end | load After | Before | at end
Total for fe of (receiv- Reba rehabil-| rehabil- of
Berve | i ganer ei) year & ing bili. | itation | itation | year &
ices ieee Serv- | tateq | Plan | plan
ices) initi- | initi-
ated 4 | ated 5
United States, total__./232, 351 | 78,045 | 72,851 | 81,455 |211, 222 | 55,825 | 7,552 | 21 075 126, 770
Ale harda be. ve cates 3 ieee 6,331 | 2, 255 542 | 3,534 | 6,783 | 1,729 255 413 4, 386
AVISKR? 2 .C2e Sones se 110 18 22 70 103 13 6 1 83
Arizona:
General cea. aster eee 961 255 274 432 574 172 37 16 349
Blinds 2s eee eee 172 55 51 66 103 ps we i 4- 69
IATRANSES Sass soe eee 4,447 | 1,402 | 1,498 1,547] 3,854] 1,113 59 329 2, 353
California) eee ae 12,703 | 2,981 | 7,828 | 1,894 | 9,933 | 2,076 | 1,197 | 1,774 4, 886
Colorado:
CLaiGR AM ect ak ne oa 1, 557 751 347 459 | 1, 564 401 177 102 884
Blind {o> oo. hep eee wee 218 54 20 144 143 29 6 6 102
Connecticut:
General’ te 3 ees ee 2,309 | 1,208 439 662 | 3,388 881 99 404 2, 004
Blinds aes eae ee 33 54 142 44 25 3
Delaware:
General. 2 SY 3459s 935 532 254 1497) 15250 452 17 102 679
‘Blind Aye eee 58 34 20 4 67 24 10 6 al
District of Columbia-_-___--_- 1, 358 540 531 287 | 1,443 284 162 160 837
Florida
Generalyhes is ot 5,339 | 1,867 | 1,597 | 1,875 | 5,595 | 1,374 174 829 3, 218
Blind see eo 2 age ee 3, 059 2i37| le TOL 1, 025 819 220 53
(FOOT MIA re ee ee seen 21,785 | 4,926 | 6,032 | 10,827 | 12,551 | 3,954 358 | 1,376 6, 863
Hawaii
Generale. 2 be sow 1, 349 145 732 472 626 2, 66 10 378
Blind. 3 es Se, 70 45 15 10 121 24 3 8 86
Idaho:
Generali) eae be 1, 333 175 676 482 417 132 30 18 237
I ite tat eat wave ee aera 34 11 ll 12 31 9 1 2 19
AN WaVoptRiis Wee seed ate eee eee 7,191 | 4,519 960 | 1,712 | 10,455 | 3,568 208 670 6, 009
Indiana:
(Jenerall 3735 4 eee es 2,492 | 1,326 546 620 | 4,336 | 1,092 130 502 2, 612
; 1B Abb Gyo Deven Renee Se ceric, 130 (6: 29 28 250 40 32 12 166
owa:
General seas! ee es 8,382 | 1,144 936 | 1,302] 2,841 785 93 262 1, 701
Ji bbalG tem Rape em omeb es 133 25 26 82 78 13 16 2
Kansas
Generaleccsd aoa ee 2, 441 695 841 905 | 1,786 532 57 171 1, 026
1S ini Saree ee ee ee 24 79 87 82 172 31 12 16
Ieentucky fase ss. ee 2, 838 779 COCR AT S5Om Qe bil 430 44 250 1, 427
Louisiana:
General sea.2! Bee 3,934 | 1, 595 925 | 1,414] 4,775 | 1,202 110 295 3, 168
Blind 2) ae ede eee 69 147 204 340 495 0 30 62
Maine
Generelt sees eee 1, 229 339 387 503 865 188 33 90 554
IBN eee a eee PE 147 23 55 69 76 22 4 2 48
Maryland see. eee sea 4,073 | 1,698} 1,194] 1,181 | 4,280 881 108 589 2, 702
Massachusetts:
ONC alee en te noe ee 3, 785 982 | 1,344] 1,459 | 2,559 706 46 185 1, 622
Blin iten se sere ae 2b 301 132 46 123 227 39 3 15 170
Michigan
Generale eigs is. eco 6,848 | 2,674] 2,085} 2,089 | 9,164] 2,666 813 293 5, 392
IBIINGE Scape oa eee 339 182 75 82 435 116 31 43 245
Minnesota:
Generalese2 22 22 ae 4, 093 035 | 1,383) 1,775) 3, 209 598 57 84 2, 470
1a) boa (6 Mite SAS Sc ape eaneetcme 381 174 112 5 395 Cie 13 26 279
Mississippi:
Clene yal Gin Jae ee 3,452 | 1, 485 Shon eL, LUI |) V3 bse 956 70 3ll 2, 195
Blind eer Riese me Mee 430 234 128 68 562 131 33 19 379
Missouri:
Generale. sae 2,525 | 1, 226 826 473 | 3,260 | 1,072 56 500 1, 632
iid eee os tee eee 398 eye 122 139 428 93 39 13
Montana
Generals eae tia Lea 1,186 428 342 416 | 1,077 376 24 45 632
Bing tek ee ee 163 10 112 41 62 2 5 50
Nebraska:
General ak. Soe ee sce 885 542 129 214 | 1,434 516 46 21 851
IB Tin Gane ce ee oa 121 29 36 56 5 30 2 1 62
See footnotes at end of table.
Office of Vocational Rehabilitation 241
Table 1.—Number of referrals and cases, by agency, fical year 1954—Con.
{Corrected to September 15, 1954]
Referrals Cases
During fiscal year During fiscal year
Re- Closed from active load Re-
Agency ! Not main- | Total main-
Ac- eae ing active ing
cepted centedl| 2° end | load After | Before | at end
Total for ae of (receiv- Reha rehabil-| rehabil- of
SOEV Wrcane. tye ing pili. | itation | itation | year ®
ices eeu Serv- | tatea | Plan plan
ices) initi- initi-
ated! | ated 5
INGWRCR) = 138 48 57 33 146 48 37 0 61
New Hampshire
Generale eee ese... .. 479 152 170 aDase/ 362 95 12 50 205
islibaveli 2 42 9s) 54 30 1133 it 84 13 4 16 1
New Jersey:
CO ROPA eee =. --- --- 2, 297 922 748 627 | 2,749 695 146 331 Ae AY
iMG eee renee 2. 481 195 196 90 510 131 15 25 339
New Mexico:
CQiGhl| i 945 239 325 381 654 217 18 21 398
{Sia oe 117 36 6 i 101 20 9 1 71
New York
Gonoraltecesten =. 55-2 - 11,065 | 4,957 | 2,537 |} 3,571 | 13,394 | 3,385 423 | 2,622 6, 964
ont) Si 934 318 205 411 797 44 59 45 449
North Carolina:
igeuctaleeee ee =| 4652535) 3,399 || 1, 534) |-15320.| 7,577 | - 2,530 85 591 4, 371
LBs hE a6 [ci 2 2 i eo a 1, 034 423 430 181 1525 294 27 123 1, 081
a ae DDG py 920 189 207 454 603 209 19 37 338
io:
Genoraleemere es... 4,068 | 1,401 | 1,091 | 1,576 | 3,306} 1,005 64 224 2,013
1BSUIAYG | oy eS ea 479 218 143 118 735 164 40 50 481
OMI nk = Ss he 736 | 1,930) |} 2,738" |) 1,068) | 6,057 | 1, 219 55 689 4,094
Oregon:
@encriiteere ers... ...| 4.768 898 | 1,902 | 1,968 | 2,448 494 68 278 1, 608
uli 149 50 54 45 154 29 6 18 101
| Pennsylvania:
| (Gemoraikesee se. 2 ok 13,387 | 4,797 | 5,482] 3,108 | 10,486 | 3,011 448 | 1,108 5, 924
| TB UN EAS 1) OE 1, 883 435 808 640 1, 416 192 66 256 902
PPACRbO dAICO wes ts. -------- 4,407 | 1,142} 1,189 |} 2,076 | 2,883 769 82 196 1, 836
Rhode Island:
Gomera ere sen 2. 716 290 250 176 912 271 55 34 552
Jes MNAG leo) he ae 30 29 0 i 178 16 2 16 144
South’ Carolina
GiOniinl | ie Se 4,827 | 1,628 | 1,499 | 1,700 | 4,563 | 1,410 66 237 2, 850
JBL K0 ee eee a 330 120 93 linhes 262 94 7 21 140
| South Dakota:
Ponerak oa. b.c-- LL =.--- 586 208 54 324 701 140 17 18 526
1 Sines 8 hs 108 28 58 22 60 14 3 1 42
Tennessee
| 2 4,529 | 1,825 890 | 1,814] 4,351 | 1,484 120 188 | 2,559
shite Ls (= 650 142 129 379 569 91 22 31 425
| ‘Texas:
fae CCI |: 10,107 | 3,024 | 2,284 | 4,799 | 9,694] 2,091 139 925 6, 539
| ii Gee | 1, 340 331 410 599 794 242 23 48 481
(| UNRe os 1,118 319 300 499 | 1,082 257 26 26 773
| Vermont
Coie. 563 219 168 176 471 105 21 45 300
leihtayo ls 5 55 20 24 11 65 14 8 4 39
Virginia:
Saeneraeees)------.-.--| 9,1438,| 3,060 | 3,229 | 2,854 | 6,531 | 1,738 78 | 1,028 3, 687
in G eee so 210 82 51 a 132 47 6 3 76
Washington:
Generale esses 222. 2. 6, 13t | 1,097 | 1,592 | 2.442). 3.404 820 103 230 2, 251
iSO)! 34 133 42 32 59 192 26 4 29 133
WeStiVaTeIniag ===) 22 -.---.. 10,894 | 3,171 | 3,502 | 4; 221 Haire || lelan le 59 | 1,336 4, 437
Wisconsin:
Genera lemeeese. 622 ts. aya | Gale 793 | 1,124 | 4,635 | 1,087 168 97 3, 283
isilag | eee Oe eee 186 87 65 34 294 67 34 8 185
Siu ie ee 880 152 354 374 462 121 54 0 287
1In States which have 2 agencies, the agency under the State board of vocational education is designated
oe AS ”” and the agency under the State commission or other agency for the blind is designated as
6 in
2 Service declined, services not needed, individual not eligible, individual needing services other than
vocational rehabilitation, referred to other agencies, migratory shifting of the individual, etc.
3 Eligibility for rehabilltation not determined.
4 Closed after rehabilitation plan was agreed upon and approved by supervising official; received rehabili-
ites oes but never reached the point of employment because of personal factors, illness, aggravated
isahility, etc
5 Closed prior to initiation of rehabilitation plan, because of indifference of individual; probable increase
in degree of disability; loss of contact, etc.
6 In process of rehabilitation on June 30, 1954.
242 _ Department of Health, Education, and Welfare, 1954
Table 2.—Total program expenditures from Federal and State funds for voca-
tional rehabilitation by State boards of vocational education, fiscal year
1954 *
Federal and State funds Classification of
expenditures
State or Territory per pee ee
and vocationa
Total Federal State guidance and Bm:
4 placement
services
Total ee eae ob) eee ce $31, 314, 797 |$19, 359, 926 |$11, 954, 871 $12, 214, 859 | $19, 099, 938
VUES oft a ays Wieleui leads PM a eee es ta oes ec a ug) 935, 030 555, 965 379, 065 348, 785 586, 245
NG ig VA 0} 80s Nea csnopionseay Seatencage pleinpen a a gs, ponent Way ct 156, 637 89, 587 67, 050 53, 725 102, 912
IAP KANSAS Soe lee ene rae as 519, 383 354, 156 165, 227 203, 027 316, 356
Californias 22 COs sea oes ree oe BS 2, 649,786 | 1,639,864 | 1,009, 922. 1,178, 295 1, 476, 491
Colorad 0 f8cee Nasser on oe eed ee amine ea 201, 755 129, 894 71, 861 97, 294 104, 461
Connecticut ia ueer sos. eee oe ae ree 396, 338 261, 805 134, 533 178, 238 218, 100
Delaware. 2 ete eee eel ee Lr eeeee tes 2 186, 541 117, 634 68, 907 82, 313 104, 228
NOTIN gee Dees bie Ue ee ee ss 867, 908 540, 348 327, 560 302, 511 565, 397
FOOT eae Ne! Seek ae Le eee mee pee 2, 500,673 | 1,375,435 | 1,125, 238 735, 836 1, 764, 837
TRAN O note ee tees Fetes eee Be et ERY Als 46, 036 25, 675 25, 336 - 46, 37,
TUT OIS Se ees ee ae ee DU ee Gee 1,804,682 | 1,173, 496 631, 186 643, 178 1,161, 504
EUCLA TNA 2 Ge we te oe ee a aR 485, 844 313, 337 172, 507 184, 488 301, 356
RO Wien iss SA Oe eee tietoky ee een regan 454, 959 251, 951 203, 008 186, 121 268,838
BCONISA Sails Deo Wize Sd oe a 266, 367 170, 442 95, 925 98, 362 168,005
IN ONGUCKY oon) ole ee = ane rad id ea 219, 896 137, 663 82, 233 103, 909 115, 987
WOUISIATI A oe ote Sede ee ee eee ed ee RL 657, 593 400, 952 256, 641 307, 550 350, 043
IVEALING 3b ee Oe ee SE eh ee 114, 561 73, 288 41, 273 43, 356 71; 205
Maryan de: 2 i 2 eer es Mpoeke, Gade aN 541, 597 319, 759 221, 838 259, 659 281, 938
Massacnusetis 20 2s -ee eas aa 403, 945 213, 598 190, 347 188, 423 215, 522
Michivan a’ :: Jere tok, ae ski ee 1, 358, 253 867, 442 490, 811 553, 332 804, 921
Minwecotasc. 1. e0 se ee ee o 399, 951 246, 523 153, 428 143, 392 256, 559
MISSISSID Dl th ecieet a oe eee ss 596, 096 279, 617 316, 479 212, 536 383, 560
IMASSOUTIC ss. See eee ea ees ae 548, 872 341, 471 202, 401 230, 400 313, 472
Montana es. o) setae ee. ee ee 179, 280 114, 873 64, 407 87, 314 91, 966
INGDTAS Kets 20% see 3 See a ee 247, 318 152, 219 95, 099 80, 643 166, 675
INGVAGAs Sees) eure oe eee Se eee 33, 606 24, 028 9, 578 14, 617 18, 989
INGW.blampshire:: ses 242. oan. 62, 920 39, 885 23, 035 22,863°| ° 40, 057
IN@weJGrsiVore st hte 2 es ee ae 2 520, 354 322, 957 197, 397 232, 003 288, 351
ING Wi MOxdCO. foe es eee ee 142, 578 85, 156 57, 422 41, 076 101, 502
New oth. Sea ee ee ee 1, 860, 925 | 1,189, 386 671, 539 847,961 | 1,012, 964
INorthi@aroling. | 225. s2 ae, oe eae 937, 791 633, 064 404, 727 264, 113 673, 678
IN Orth WDako tae cago a ee eae ae 147, 324 86, 329 60, 995 43,171 104, 153
<0] af RPO ae stg ae SE OPA Sy eyes ee 2) ke 2 A 490, 730 339, 171 151, 559 211, 295 279, 435
ORIGH OMA Loe oe ese ioe bares ae eee 754, 215 468, 720 285, 495 280, 402 473, 813
Oresonde gees Re eee As 364, 607 252, 504 112,103 159, 541 205, 066
PEHNSVIVANIs oe 5 oe ge ee eae ae 1,955,470 | 1,330, 960 624, 510 770, 378 1,185, 092
Rhoder island eustar oe see ees eae 127, 835 81, 625 46, 210 48, 722 79, 113
SouthiGaroling ke ee ee oe 2 616, 827 432, 136 184, 691 264, 871 351, 956
POUtMODAKOLAG see. eae nee ene We 105, 029 60, 497 44, 532 29, 529 75, 500
APONNESSCO Soe a eels Soe See he oe a 822, 257 497, 167 325, 090 293, 068 529, 189
XAG eas oi AOE ae he, dees eee 1, 290, 204 774, 054 516, 150 459, 828 830, 376
4 G2) a SS Vela ORIENT, Sian ea pe Saige ee oY 2 Nad 140, 796 108, 254 32, 542 76, 698 64, 098
Wenrmont cece sce es ee Map ae 121,152 76, 038 45, 114 38, 676 82, 476
Warminid snc. sees pad. atte ee eee 724, 123 440, 145 283, 978 269, 493 454, 630
WASHINGTON. =e hire) Ae eee a 725, 165 434, 438 290, 727 331, 822 393, 343
WesteVirginia ss tanto. eee seen mee ay 818, 058 491, 829 326, 229 315, 092 502, 966
WASCONSET oh Ge VUE Se pee Wns) Scere 692, 782 435, 823 256, 959 269, 294 423, 488
WV VOMIT Oe et See ee a re 114, 995 80, 288 34, 707 45, 704 69, 291
Si 2 SY We ae PP ea cent Ns Te 64, 808 39, 165 25, 643 26, 219 38, 589
Districtiol Columbia. 2.00 = 22 sama 251, 763 166, 763 85, 000 135, 259 116, 504
GUN CAME a eTocs aes oe ea age a 220, 406 126, 409 93, 997 69, 059 151, 347
IETGOURICOl ssa cae 2 cee eae) 448,101 275, 780 172, 321 131, 082 317, 019
1 Based on reports from States, subject to audit.
Office of Vocational Rehabilitation
243
Table 3.—Total program expenditures from Federal and State funds for voca-
tional rehabilitation of the blind by State commissions or agencies for the
blind, fiscal year 1954 *
Federal and State funds
State or Territory
Total
“DOYS. a a $3, 586, 811
ASOT AOSD, 26 1 J 43, 420
CONCTIOTERNG (0, = A gl 38, 190
COVERING 9 (0) Fp ES eet ee ea 42, 001
etiwianbereeeeeee sf oe etc 47, 937
LEO KG Ny ig pas SS, 267, 965
LS ESIOYO). cs US GS a 14, 361
Giantess ek 47, 622
ONDE = oe eh es ees ee 23, 357
ESE OSES 5) a ey 2 80, 597
PeOMisignaeeen sees ren ne a Ll 85, 648
WIG HIG YE) 2s Uh NI ap 30, 444
Massachusetts:_...-....2.--..-.---..- 50, 872
MiGIIO Mime een ee 137, 590
MMM CSO tReet ie eo 9S. ne 132, 956
IB EAS) SST) 0 bee a 153, 561
(aod te ra 122, 386
WOM AAp ere ee ee eS eel 26, 861
INQ RROS oe 50, 016
New: Erampshire..2.- 22.2252... .-... 23, 385
ING UGS ase ae a ee 125, 048
New Mexi¢os2- so. 0 ooo Seek elke 29, 318
BNC WaGOn Kee Sere ek 372, 958
North Caroling! -*. 222502 4.2.2-2 21k 317, 538
UO NEP eae 4 re 176, 180
OrecOieeteeeweeneme soe dC ele 57, 104
Penis viwnidees 2-2 2s. 374, 309
hod epislanderes. oe. y= sn 30, 875
SOUCM@arOliMtac ee eos ak 49, 224
SoupmeDakotas. = oo. cede aces-e 26, 894
RCIA ESCOO mee ee ee eke 166, 029
BING Ke Guenevere Se ee 204, 274
WESDTOT. C8 ee ee 19, 793
\VSURSR NST ey is SF 42, 058
WAS GOMeer ere oN 48, 608
WASCOMSIMGmeeuemnns Sethe Ne ee 84, 823
REL Wil lemee eC nee ee 42, 609
1 Based on reports from States, subject to audit.
Federal
$2, 401, 755
28, 685
29, 801
27, 397
29, 622
168, 924
12, 325
41, 424
18, 479
46, 593
70, 914
16, 673
34, 071
86, 229
62, 961
90, 162
93, 189
16, 848
33, 283
10, 396
93, 830
21, 581
232, 782
226, 263
126, 258
37, 650
237, 367
22; 992
39, 549
16, 590
122, 816
146, 537
14, 961
28, 768
29, 799
59, 622
26, 414
Classification of
expenditures
EET
and vocationa.
State suidance and | Purchased
placement services
services
$1, 185, 056 $1, 933, 321 $1, 653, 490
14, 735 22, 141 21, 279
8, 389 25, 830 12, 360
14, 604 27, 047 14, 954
18, 315 21, 019 26, 918
99, 041 158, 499 109, 466
2, 036 10, 289 4, 072
6, 198 35, 226 12, 396
4, 878 13, 601 9, 756
34, 004 44, 217 36, 380
14, 734 65, 392 20, 256
13, 771 21, 517 8, 927
16, 801 30, 765 20, 107
51, 361 84, 849 52, 741
69, 995 75, 996 56, 960
63, 399 83, 235 70, 326
29, 197 69, 282 53, 104
10, 013 18, 165 8, 696
16, 733 23, 093 26, 923
12, 989 12, 637 10, 748
31, 218 70, 844 54, 204
7, 737 13, 845 15, 473
140, 176 145, 529 227, 429
91, 275 134, 987 182, 551
49, 922 110, 005 66, 175
19, 454 21, 724 35, 380
136, 942 183, 092 191, 217
7, 883 20, 183 10, 692
9, 675 35, 419 13, 805
10, 304 13, 659 13, 235
43, 213 81, 880 84, 149
57, 737 116, 636 87, 638
4, 832 13, 963 5, 830
13, 290 15, 478 26, 580
18, 809 40, 097 8, 511
25, 201 53, 279 31, 544
16, 195 19, 901 22, 708
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Saint Elizabeths Hospital
THE Primary responsibility of the hospital is the proper care of
the patient. The entire organization of the institution revolves about
him. Medical care of the patient in Saint Elizabeths Hospital is
assigned to the three Clinical Branches and the Medicine and Surgery
Branch, the latter including the tuberculosis service. All of the other
activities of the hospital, such as social service, nursing, dietetics,
construction and maintenance, are auxiliary to these four Branches.
Division of Medical Services
The program of psychiatric and general medical care and treatment
of patients carried out in the various branches of this Division during
the year is outlined below.
CLINICAL BRANCHES
Each Clinical Branch, comprising 2,000 or more patients, 1s in
charge of a Clinical Director. The activities of these Clinical
_ Branches deal primarily with the psychiatric treatment and care of
_ the patient as well as the education and research activities of a clinical
_ nature. These services have been maintained at an acceptable standard
during the year, despite still growing difficulties of overcrowding and
shortages of personnel, as previously reported.
Problems of overcrowding have been mentioned in previous re-
ports, but they are continuing and are pressing. The same may be
said of the shortages of professional and ward personnel. The un-
pleasant fact is that the number of patients, despite all efforts to dis-
charge them promptly, is growing; furthermore, the average age of
the patients is increasing and the tendency of these patients is to
| remain in hospital longer. Although new buildings have been author-
245
246 ; Department of Health, Education, and Welfare, 1954
ized recently, they have been accompanied by the required destruction
of other patient space; thus the net result has not been an increase in |
proper bed capacity of the hospital. The Geriatric Building, for
example (in which one ward is still vacant), replaced the so- -called
semipermanent buildings which actually had a capacity of slightly
more than the Geriatric Building.
The proper bed capacity of the hospital at present stands at 6,276,
there having been opened during the year one ward of 63 beds in the
Geriatric Building which had on account of lack of personnel lain
idle since that building was occupied. There were actually in the
hospital on June 30, 1954, 7,229 patients, an excess of 953, or 15 percent
over the actual .bed space. Rather than having overcrowding, there
should be at least 10 percent vacant beds available at any time in order
to have the proper mobility of patient load. It may be added that the
proportion of ward personnel has not increased with the patient
population; the ratio is approximately 25 percent below that con-
sidered proper by the American Psychiatric Association.
During the year an attempt was made to lighten somewhat the load
of the overworked staff members by adding general practitioners and
externs. They have been very helpful with carrying out some of the
routine medical activities on the wards, and have freed some of the
time of the clinical staff as planned. The staff has been energetic,
efficient, and devoted in its work and deserves high praise.
It was reported last year that it was necessary to establish a wait- —
ing list of prisoners found mentally ill. This has been due to the —
fact that crowding cannot well take place in Howard Hall, the maxi-
mum security section. The situation is not at all as it should be and —
it is hoped that speed may be shown in providing a new maximum ~
security section, funds for the preliminary planning of which will —
become available at the beginning of the new fiscal year. Every
effort 1s being made to reduce the waiting list as far as possible con-
sistently with the safe administration of the maximum security section.
Howard Hall contains some of the most serious problems among the
entire male population of the hospital, and crowding and understaff-
ing are particularly dangerous in dealing with this group.
The program in Howard Hall should be mentioned briefly, as it
represents the culmination of several years of a new approach to the
care of patients of this type. Every effort is made to cultivate an _
atmosphere which is reasonably permissive. Patient self-government _
is in operation; smokers are held regularly at which guest speakers _
address the patients in attendance. Each new patient is taken on a _
tour of Howard Hall by another patient (accompanied by an attend- —
ant) for the purpose of orienting him and introducing him to the 4
other patients. Entertainments have been carried on.
Saint Elizabeths Hospital 247
A very active art program has been underway. A journal is
published regularly. The results have been most gratifying and have
demonstrated that even though Howard Hall is technically for more
serious problems the atmosphere need not be unduly repressive and
that a progressive therapeutic program gives ample reward.
The difficulties in filling medical positions in the hospital continue
to exist. In the first place, the number of internships and residencies
available in this country exceeds considerably the number of gradu-
ates from medical school and the number of graduates desiring to take
up postgraduate study in special fields. Furthermore, the financial
returns from the private practice of psychiatry are most tempting,
the result being that very few of the residents care to stay in hospital
work once their training is completed. It is obvious that the Gov-
ernment can never expect to equal the financial return that the success-
ful private practitioner of medicine might make in the community.
There are, of course, other factors which operate in making govern-
mental work in a hospital attractive. Finances, however, cannot be
overlooked, and once again it is pointed out that the fact that another
agency of the Government is permitted by statute to pay a salary
premium of 25 percent to diplomates of specialty boards puts Saint
Elizabeths Hospital in a position in which it cannot compete on an
_ equal footing with that agency. Certainly it seems absurd that one
_ agency of the Government should be put at such a disadvantage in
- competing with another agency which is doing similar medical work.
_ The elderly patient continues to be a serious and growing problem.
_ Approximately 40 percent of the patients admitted now are 60 years
_ of age or older, and there is no prospect that this proportion will
decrease. In fact there is every reason to think that it will increase
_ as the number of aged in the community continues to rise. Every
| effort has been made during the year to find homes for these patients
outside of the institution when continued psychiatric care was not
| necessary and a considerable number have been sent to the District of
| Columbia Village, as it is now known (formerly the Home for the
_Aged and Infirm). Several clinical studies have been made on
_ patients in the Geriatrics Building, and the building itself continues
_ to attract a large number of visitors from this and other countries.
_ The number of patients admitted to the hospital voluntarily con-
| tinues to rise; during the year 111 patients were received in this
| manner.
The number of so-called sexual psychopaths committed under the
“Miller Act” showed a very slight increase over last year, there being
_eight admissions of this sort. Up to date, 69 persons have been
admitted under this act, and of them 43 have been discharged. The
| hospital is prepared to recommend certain changes which will make
2438 Department of Health, Education, and Welfare, 1954
eta a a ce
the act more flexible and probably on the whole considerably more
useful. | a
During the year the hospital has been honored by the visits of
physicians, social workers, and other interested persons from no less
than 25 countries. Visitors from other countries as well as visitors
from other parts of the United States are always most welcome, and
their visits are a stimulating influence upon the staff as giving recog-
nition to the fact that the hospital enjoys a good reputation through-
out the psychiatric world. During the year one psychiatrist from
the Netherlands spent several months as an observer, and a psychiatrist
from Japan, sent by his government, has spent nearly the entire year
studying particularly the activities of the maximum security section
of the hospital.
During the year the patients gave two dramatic performances, one
a Christmas program and the other a very clever and good-natured
satire on the hospital entitled “Hotel St. Elizabeths,” this latter pro-
duction being conceived, staged, and acted by the patients. The per-
formance was a remarkable one, especially from the fact that it
emanated from the patients themselves. A large number of visitors
from the community attended, to the great pleasure of the patients.
During Mental Health Week an “open house” was held and at least
500 persons from the community visited the institution. This public
interest is most gratifying and illustrates the growing understanding
by the public of the aims and aspirations of mental hospitals.
The hospital still attempts to follow an eclectic approach in the
line of treatment, and is ready to utilize any new methods of treatment
which appear to offer help to the patient without incidental harm to
him. The hospital has no undue devotion to any preconceived
notions as to psychopathology or treatment and no devotion to what
Isaac Ray, one of the fathers of psychiatry in this country, was wont
to term “ultraisms.” An active program of individual psychotherapy
is carried on, and likewise the same is true of group therapy. There
are many groups under therapy in various parts of the hospital and —
with great benefit to them. During the year the psychodrama pro-
gram was resumed when the psychodramatist who had done much
to develop the work before his leaving returned to the hospital. The
rehabilitation program has been developed still further with great
assistance from the District of Columbia Rehabilitation Service. The
Board of Education of the District of Columbia has provided a visit-
ing teacher for some of the young patients of the hospital. Recrea-
tional and occupational therapies have been extended. The hospital —
has no idea that electroshock is a panacea, but in selected cases its use
exhibits striking effect. Subshock insulin and hydrotherapy continue —
to be used. The hospital is convinced that hydrotherapy still has —
an active place, despite the views (we think mistaken) of some that —
| Saint Elizabeths Hospital 249
it has been superseded by the so-called shock therapies. We continue
to look upon prefrontal leucotomy, or lobotomy, as an operation only
of last resort, and it is employed only after all of the known applicable
forms of therapy have been tried without benefit. Only 13 lobotomies
were performed during the year. The transorbital variety of lo-
botomy is not employed at the hospital at all.
Hearings on petitions for writs of habeas corpus continue to occupy
a substantial share of the time of staff physicians. During the year
41 hearings were held on such petitions, and 11 orders to “show cause”
had to be answered. Altogether, 29 of the patients were remanded,
and 5 withdrew their petitions.
MEDICINE AND SURGERY BRANCH
This Branch functions through the Medical, Surgical, Neurological,
Syphilological, and Clinic Services. The hospital is still the only
public mental hospital in the United States which is approved by the
American Medical Association for rotating internship. It is also
approved for a period of residency training in surgery and for intern-
ship in dentistry. The services of this Branch are available to the
patients of the hospital who are in need of medical or surgical atten-
tion of a specialized nature and to those employees who become ill or
are injured while on duty. During the year, 2,233 patients were
admitted to the wards of the Branch, while a total of 53,226 visits to
the clinics were made. In addition to the extensive work done in the
laboratory, over 12,000 laboratory examinations were made in the
Medical and Surgical Branch. The plan developed last year by which
two fourth-year residents in surgery from George Washington Uni-
versity Hospital cared for the surgical needs of the institution has
worked excellently. These residents are supervised by daily visits
of the various members of the surgical teaching staff of that hospital,
and the surgical attention given to the patient is of a high order.
The Neurological Service is in a state of suspended animation ex-
cept for the attention which an occasional visiting neurologist can give
it. In the treatment of tuberculosis it has been found that surgery
is not so frequently necessary as was thought a few years ago, the
effects of the antibiotics being most satisfactory. Various clinical
studies have been carried on in conjunction with other Federal medical
agencies. The training program for the interns has been augmented.
The dental program has suffered somewhat by the lack of dental
interns and available staff dentists.
PSYCHOTHERAPY BRANCH
During the year the psychodrama was reactivated, with the return
of the former psychodramatist. The program of rehabilitation psy-
839010—55——17
250 Department of Health, Education, and Welfare, 1954
ea a
chodrama instituted last year has continued. An extensive program
of group psychotherapy is under way throughout the hospital, super-
vised by a visiting consultant. Individual psychotherapy 1 is carried
on by several members of the branch, as well as by various other staff
members. The art and dance sessions have continued to do much for
the resocialization of patients by giving them opportunities for self-
expression. The exhibit of Art in Psychotherapy, prepared a year
ago, has continued on tour, and has attracted wide and favorable atten-
tion. The contributions of those in charge, Miss Marian Chace and
Mr. Prentiss Taylor, are truly unique.
The Psychology Section continues to function actively. During
the year, 2,684 tests were given, to patients, attendants and other
personnel. In addition, lectures have been given to residents, nurses,
psychiatric aides, and groups of students from nearby colleges. Voca-
tional testing and counseling and s some individual psychotherapy have
been carried on.
The training program is likewise important. Two residents and
four interns have been supervised during the year, besides a number
of field students and volunteers. Five research programs are under
way.
LABORATORY BRANCH
This Branch continues to be very thoroughly occupied by the de-
mands from the Medical and Surgical and the Clinical Branches. As
yet there is no trained encephalographer, but various changes have
been made in the staff and organization of the laboratory which will
take effect soon after the beginning of the next fiscal year. The
autopsy rate has continued fairly high. During the year there were
416 deaths with 223 autopsies, or a rate of 53.6 percent. An active
program of lectures for the benefit of the residents and the rest of
the staff has been carried out and a number of researches are under-
way, among them studies of brain chemistry and the effects of thora-
zine and serpasil.
The work of the year may be summarized as follows:
Bacteriology (cultural studies of autopsies and exudates, examination of
smears, Cte.) 2. eed oe te fee Bo 6, 284
Serology (blood typing and cross matching, ete.) ~--._-_______-_______ 16, 110
Urine analyses... 2 ee oe 40, 111
Blood and feces examinations_..._.-----.___<____ = 13, 608
Biochemistry (blood analyses and tests, functional tests, including elec-
trocardiograms and basal metabolisms) ~-.-__--__-___-_-_-_-__§_-_-_- 11, 068
Blectroencephalograms 02 187
Histopathology (surgical pathology and post-mortem pathology) -_-_- 6, 628
Autopsies (percentage of deaths 53.6 percent)
Photography 2220 sooo ie es On ee eo ee 7, 568
Saint Elizabeths Hospital 251
NURSING BRANCH
During the year a program of training for psychiatric aides has
been inaugurated, and 25 carefully selected employees of the Hospital
have started in this course. Eight schools of nursing are sending their
affiliate students to the hospital, and during the year 215 affiliates have
been trained. In addition a group of Navy corpsmen has been under
training. Eighteen practical nurses completed their training during
the year. In addition, opportunities for field service have been given
to the Graduate School of Nursing of Catholic University.
OCCUPATIONAL THERAPY BRANCH
The work of this Branch has continued actively, and the ward
programs have been substantially expanded. Some of the recreational
activities were transferred during the year to the Special Services
Branch. The Branch continues to care for the recreational activities
in Howard Hall, and has carried on a number of very desirable and
helpful plans there. Five schools of occupational therapy use the
hospital for field training.
SOCIAL SERVICE BRANCH
During the year, 1,649 patients were given services, with a total
of over 7,841 interviews. Although this shows something of a de-
crease from the year before, much intensive work has been done by the
Branch, particularly with relation to some of the long-term patients.
During the year, for example, three patients for whom homes were
found had been admitted respectively in 1926, 1932, and 1936! This
activity takes much time, but it is certainly a highly desirable one,
and is being encouraged. It is this activity, incidentally, which
accounts in large measure for the increased average stay of patients
discharged during the year. The branch has worked in close coopera-
tion with the rehabilitation service worker and plans are being worked
out with the Public Assistance Division of the Department of Public
| Welfare to enable patients to obtain payment of the funds due them
_ from Public Assistance sources. It should be pointed out that under
the laws of the District of Columbia a patient who is committed to
Saint Elizabeths Hospital loses by that fact all of his legal rights,
_ and until he is discharged as recovered he is not sué juris. This fact
| operates to the distinct detriment of patients, and it is hoped that
| when the commitment laws of the District of Columbia are finally
| brought up to date this particular feature may be eliminated. There
_ is no essential legal reason why commitment to a mental hospital
| should operate as an adjudication of incompetency. One interest-
ing activity of the Social Service Branch during the year has been
252 Department of Health, Education, and Welfare, 1954
ach el nm ec sb cr, DMA Rn i ini Niche
the operation of a relatives’ discussion group conducted weekly by one
of the social workers. This has proved distinctly valuable in orient-
ing relatives to the various activities of the hospital and the various
reactions which their relatives who are patients may exhibit.
During the year 10 social-work students from Catholic University
and Howard University have been under supervision.
CHAPLAIN SERVICES BRANCH
Regular services have been conducted for the Catholic, Protestant,
and Jewish patients. These services have been well attended and
every effort is made to enable every patient to attend the services, pro-
vided his physical and mental condition permits. Those patients who
are unable to attend the services are given such religious attention as
they desire on their wards. Regular services have been held in Hitch-
_cock Hall, Howard Hall, and the Geriatric Building. The Hospital
has two full-time Protestant chaplains, a full-time Protestant resident,
a full-time Catholic chaplain, and a regular part-time Jewish chap-
lain. During a part of the year the Catholic chaplain was aided by
another part-time priest and plans are underway to give him such
additional assistance as he requires in his duties. The Catholic chap-
lain is also aided to a very considerable extent by the services of semi-
narians. The Protestant chaplain is in charge of the general training
program for theological students as well as carrying out his duties of
parochial and sacramental services for the Protestant patients.
During the year 24 students or ordained clergymen have completed
the prescribed period of training. This year marks the completion of
10 years of this training program, a program which has attracted
wide attention and which has done much toward orienting the clergy
toward the problems of mental illness and mental health, as well as
doing much to provide well-trained institutional chaplains.
The chaplains of the various faiths have worked closely together,
and a high degree of friendly cooperation has existed among all of
those who are ministering to the religious needs of the patients. It is
the general policy of this hospital that every patient admitted should
be visited by a representative of his faith as soon as possible after his
arrival at the institution. In addition, any patient may have his own
clergyman or a clergyman of his own denomination visit him from
the outside if he so desires. Jewish services have been held regularly
under the supervision of the Jewish chaplain and with the assistance
of the Jewish Welfare Board.
It is a pleasure to report that the interdenominational chapel, the
need of which has been acutely felt for a number of years, is finally to _ : ,
become a reality. Funds have been made available; plans are under __
way. It is possible that during the coming year the building may not @
only be started but completed.
Saint Elizabeths Hospital . 253
LIBRARY SERVICES
The Medical Library is operated primarily for the benefit of the
medical staff. There are also collections in the offices of the Nurses
Training School, the Medical and Surgical Building, Laboratory,
Geriatric Building, and Psychology Section. During the year there
were 535 acquisitions, bringing the total number of volumes to 16,598
- in addition to about 15,000 miscellaneous pamphlets. Periodical sub-
scriptions, by purchase or gift, come to 184. About 1,831 volumes were
borrowed by the staff, and 405 volumes were secured on interlibrary
loan. The Armed Forces Medical Library, the Library of Congress,
and the Library of the Department of Health, Education, and Welfare
have been most helpful. The quarters of the Medical Library are
seriously overcrowded. Once again it is urged that arrangements be
effected to permit the use of commercial binders as a saving in time
and expense.
The Patients’ Library is in charge of one employee who is assisted
by about 25 patients. During the year there were 1,459 accessions,
most of them by gift; there are now 40,355 volumes in the library or
in the numerous ward collections. The circulation is about 5,500
volumes per month. Patients visit the library, and those patients
who are unable to do so are provided with a variety of reading matter.
Numerous book-review sessions are held at the library; these are well
presented and attended. The quarters of the library are seriously
crowded.
SPECIAL SERVICES BRANCH
The Special Services Branch, originally set up to take over the
functions of the Red Cross when that discontinued its services in
September of 1952, has continued to function most efficiently. It
has continued to have close relations, not only with the District of
Columbia Chapter of the American Red Cross but with various other
agencies, such as the American Legion and the Legion Auxiliary.
Over 2,824 volunteers served under the direction of this Branch dur-
ing the year, giving a total of 8,193 hours. In December 1953 most
of the hospital recreational activities were added to the functions of
this Branch and have been carried on well. The Branch assisted
admirably in staging the two dramatic performances already men-
tioned, held carnivals and play days, established a chorus and served
in multifarious ways to provide various recreational activities for
the patients, both at the Red Cross House, on the grounds, and on.
the various wards. Thanks are particularly offered to the various
organizations which have served, particularly to the Motor Corps,
| Canteen Service, the Production and Supply Service, and the Gray
Ladies of the American Red Cross. Many evening parties, dances,
254 Department of Health, Education, and Welfare, 1954
and concerts have been conducted, and the Red Cross House has been
kept open every day, serving 10,000 or more persons every month.
TEACHING ACTIVITIES
The hospital continues to carry on an extensive program of teaching
and training. It is approved for training in psychiatry during the
three years of residency required by the American Board of Psy-
chiatry and Neurology as a prerequisite for diploma. This program
is in charge of a well-trained psychiatrist, who serves under the First
Assistant Physician. A schedule of lectures is arranged and indi-
vidual guidance is given to the various residents. ‘The hospital is also
approved for a rotating internship, and affiliation is provided at the
District of Columbia General Hospital for the interns and at. the
George Washington University Hospital for the residents. Instruc-
tion is provided for medical students in the three medical schools of
the District; namely, George Washington, Georgetown, and Howard
Universities. Dental interns and residents in surgery are also serving
in the hospital. The Social Service Branch is actively providing field-
work for the schools of social service of Catholic University and
Howard University, and students of occupational therapy are like-
wise received for fieldwork. Supervision is given to interns and resi-
dents in the field of clinical psychology. Affiliation for undergraduate
nurses and postgraduate nurses is being continued. oy aS os oe aS 6, 484 1, 339 891 66. 54 424
OAS eeppeertremerr er We 2 eS ee kseik 6, 621 1, 420 856 60. 28 431
WY) ee 6, 701 1, 470 861 58. 60 446
HG) i) ee a ee 6, 897 1, 648 960 58. 25 495
LO Olam een We ee tee So Sa a Sek 7, 053 1, 412 928 65, 72 424
WORD ante aoa Se rr a 7, 172 1, 438 814 56. 6 431
NORE OL es a eae ee ee 7, 361 1, 524 977 64. 1 436
0 51 eee ome Se a eel 7, 392 1, 385 921 66. 5 416
163.10 without transfer of 400.
Table 2.— Movement of patient population, fiscal year 1954
Male Female
Total
White | Colored | Total | White | Colored | Total
Total number under care and treatment .
fisealbveamdGn4) e222 ok c a 8, 767 | 2, 783 1,653 | 4,486 | 2,635 1, 696 4, 331
Remaining on rolls June 30, 1953_._..-.-- 7,382 | 2,358 1,389 | 3,747 | 2,179 1, 456 3, 635
Admitted during year:......=-.-------- 1, 385 425 264 689 456 240 696
Total discharged or died___._---.-------- 15337 436 248 684 416 237 653
IMischancediaeeore. 220s oe ese 921 298 188 486 265 170 435
Discharged as—
ING@tubisamest=. 255 255032328. 44 16 26 42 1 1 2
IReCOvereds os. 2 lk ssc 125 24 38 62 32 31 63
Social recovery_=2--.=2.----.-4.-- 291 66 50 116 97 78 175
1600) CeCON Ye a ae ee 271 123 42 165 72 34 271
Wnimroveda- es 2s See. 190 69 32 101 63 26 89
TOG Lae oS 416 138 60 198 151 67 218
Remaining on rolls June 30, 1954___..__-- 7,430 | 2,347 1,405 | 3,752 | 2,219 1, 459 3, 678
On visit or elopement......---------- 201 39 34 73 80 48 128
eel oe 7,229 | 2,308 1,371 | 3,679 | 2,139 1,411 | 3,550
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258
American Printing
House for the Blind
As THE Official schoolbook printery for the blind in the United States,
one of the principal functions of the American Printing House for the
Blind, in Louisville, Ky., is the extension of its services to the schools
and classes for the blind through the Federal act “To Promote the
Education of the Blind.” This act, originally passed in 1879, au-
thorizes an annual appropriation to the Printing House to provide free
school texts, tangible apparatus, and supplementary materials neces-
sary in the education of the blind. Allocations of books and materials
are made to the several schools on the basis of their enrollments. Only
those pupils may be registered whose vision comes within the accepted
definition of blindness as follows: “Central visual acuity of 20/200 or
Jess in the better eye with correcting glasses, or a peripheral field so
contracted that the widest diameter of such field subtends an angular
distance no greater than 20°.”
The Printing House maintains large catalogs of Braille books, 'Talk-
ing Books, Braille music publications, large-type texts, and tangible
apparatus. ‘The schools for the blind are thereby provided with a
rich collection of educational material from the kindergarten through
high school. There are approximately 7,041 blind children enrolled
in the residential and public school classes for the blind being served
by the Printing House.
During the 1954 fiscal year, Braille books, educational periodicals,
and music made up approximately 58.43 percent of the materials re-
quired by the schools; Braille slates, Braille writers, maps, and other
mechanical devices about 12.60 percent; Talking Books about 5.66 per-
cent; and large-type books about 20.81 percent. Approximately 2.50
percent was used for miscellaneous items.
259
Gallaudet College
GALLAUDET CoLLEGE is devoted to the education of deaf persons who
because of their handicap are unable to make satisfactory progress in
schools and colleges for hearing students. The college, located in
Washington, D. C., is the world’s only college for the deaf. In addi-
tion to education, it conducts research into the educational problems of
deafness. It consists of the Kendall School and the college proper.
KENDALL SCHOOL
Primary and secondary schooling is provided for deaf children in
the Kendall School, which also serves as a laboratory school for teach-
ers training in the college. The oral method of instruction is used for
all pupils except those who make no progress under it. Enrollment
last year was 81, of which 68 came from the District of Columbia.
GALLAUDET COLLEGE
The college, established in 1864 by act of Congress, offers the as-
sociate’s degree after 2 years of study and a bachelor’s degree in the
liberal arts and sciences. The Preparatory Department provides the
senior year of high school for students who are unable to obtain it in
the State schools for the deaf. The Graduate Department of Educa-
tion offers a master’s degree and a professional diploma in the educa-
tion of the deaf to students with normal hearing. ‘Total enrollment
in the college last year was 259 with students from 36 States, the Dis-
trict of Columbia, and 9 foreign countries.
261
Howard University
Howarp University was chartered by the act of Congress on March 2,
1867. Located in the District of Columbia, the university operates an
undergraduate college, a graduate school offering the master’s degree,
and eight professional schools as follows: medicine, dentistry, phar-
macy, engineering and architecture, music, social work, law, and
religion. (Religion receives no support from Federal funds.)
ENROLLMENT OF STUDENTS
During the school year 1953-54, Howard University served 5,268
students as follows: 3,898 during the regular school year, 1,024 in
summer school, and 3846 in the evening school. The net total enroll-
ment, excluding all duplications, was 4,768 students, distributed as
follows: 346 in the evening school and 4,422 in the 10 regular schools
and colleges as follows: liberal arts, 2,235; graduate school, 334;
engineering and architecture, 3872; school of music, 252; school of
social work, 110; college of medicine, 298; college of dentistry, 499;
pharmacy, 161; law, 116; and school of religion, 45.
GEOGRAPHICAL DISTRIBUTION OF STUDENTS
Of the net total of 4,422 students enrolled in the 10 regular schools
and colleges, 3,896 were registered for degrees. ‘Three thousand five
hundred eighty-three of these, or 92 percent, came from 38 States and
the District of Columbia, while 313, or 8 percent, were students from
outside of continental United States, including 30 countries in Africa ;
Asia; North, Central, and South America; 10 island possessions of the
British West Indies; and 4 United States possessions.
The 38,588 students from the continental United States were
distributed as follows:
263
264 Department of Health, Education, and Welfare, 1954
From the North, 898 students as follows:
New Hngland__-__o--2-- 2 oust 19
Middle Atlantic States... 3 eee 538
East North Central States_..._....__.__--..:_._...___ ee 204
West North Central States____....-__.-.u-2222.-2-_ 2 eee V7
Total from; the North. 23.3 W253) 333 eee 898
From the South, 2,658 as follows:
South Atlantic States.._._.-.._..-._..._._..-..2. 2 2, 182
South Central States._.j- ....2-=:- 2. =i eee 291
West South Central States._..._....-_______...__ eee 235.
Total from the South.....__-__..___.__.....1_ ee 2, 658
From the West, 27 as follows:
Mountain States.20 002. ee ee 6
Pacific States_.. 02. ne ee eee 21
Grand total degree students in continental United States____ 3, 583
The 818 from foreign countries and United States possessions were
distributed as follows: 59 students came from the following countries
in Africa: Algeria, Egypt, Gold Coast, Liberia, Nigeria, Sierra-
Leone, and Tunisia. Twelve students came from seven countries in
Asia as follows: India, Indonesia, Iran, Israel, Japan, Malaya, and
Syria. One hundred thirty-five came from ten island countries in the
British West Indies as follows: Barbados, Bahamas, Bermuda, Gren-
ada, Jamaica, Montserrat, Novis, St. Vincent, Tobago, and Trinidad.
Three students came from Canada. Nine students came from the
following countries in Central America: British Honduras, Cuba,
Haiti, and Panama. Seventeen students came from the following 10
countries in Europe: Belgium, Czechoslovakia, England, Germany,
Greece, Holland, Italy, Poland, Russia, and Spain. ‘Thirty-nine stu-
dents came from British Guiana in South America. Thirty-nine
students came from the following United States possessions: Canal
Zone, Hawaii, Puerto Rico, and the Virgin Islands.
THE COMPREHENSIVE PURPOSE OF HOWARD UNIVERSITY
From the beginning of its life and throughout its history, Howard
University has welcomed students from every area of American life,
without discrimination as to race, creed, color, or national origin.
It has likewise welcomed any and all such persons to membership in
its faculties, on the basis of their ability and character as individuals.
HIGHLY SIGNIFICANT SERVICE TO NEGRO STUDENTS
One of the major purposes of the founders of Howard University
was the admittance of Negro youth, among others, to all of its educa-
Howard University 265
tional offerings. The institution has pioneered in the offering of pro-
fessional training to Negro youth in medicine, dentistry, pharmacy,
engineering, architecture, law, music, and social work, as well as in
the teaching profession.
During the entire period of 89 years from 1865 to 1954, Howard
University has been the only university of public support in the
Southern States which has offered to a substantial number of Negro
youth any approximation of the wide scope of undergraduate, grad-
uate, and professional studies characteristic of American State in-
stitutions.
Since 1948, public institutions in 12 Southern States, hitherto closed
to Negroes, have, little by little, opened their doors to Negro youth;
but in the year 1954 Howard University still enrolled a larger number
of students in accredited schools of medicine, dentistry, pharmacy,
music, engineering, and architecture, and social work than in all other
public and private universities and colleges together in the entire
area of the Southern States.
The national importance of Howard University as a trainer of
Negro professional students 1s nowhere better illustrated than by ref-
erence to medicine and dentistry. If Meharry Medical College of
Nashville, Tenn., alone be excluded, the enrollment of medical and
dental students at Howard University in 1954 exceeded the enroll-
ment of Negro students in all the other medical and dental schools in
the United States. Howard University and Meharry Medical Col-
lege have been the responsible pioneers in the development of medical
education among Negroes; and, today, they constitute, by far, the
major source of Negro physicians, surgeons, and dentists in America
and in the world.
VETERANS
There were 5/4 veterans enrolled at Howard University during
the school year 1953-54 as compared with 578 in school year 1952-53.
Of the total veterans enrollment in 1953-54, 354 were World War II
veterans; while 220 were Korean veterans. These enrollment figures
indicate a drop of 135 in the enrollment of World War II veterans
and an increase of 131 in the enrollment of Korean veterans.
During the two semesters of the regular school year, the veterans
were distributed among the 10 schools and colleges of the university
as follows: in the graduate school, an average of 28 per semester; in
liberal arts, an average of 214; in engineering and architecture, an
average of 76; in music, an average of 10; in social work, an average
of 6; in medicine, an average of 28; in dentistry, an average of 29;
in pharmacy, an average of 28; in law, an average of 80; and in re-
ligion, an average of 6.
339010—55 18
266 Department of Health, Education, and Welfare, 1954
The relation of the veterans to the total enrollment in the 10 schools
and colleges ranges from a minimum of 6.25 percent in social work to
a maximum of 29.50 percent in law, with an average of 13.65 percent of
the total average enrollment of the 10 schools and colleges during the
two semesters of the regular school year.
ARMY AND AIR RESERVE OFFICERS’ TRAINING CORPS
Army Reserve Officers’ Training Corps.—T wo hundred and eighty-
two students were enrolled in the Army Reserve Training Corps dur-
ing the school year 1953-54. Two hundred seven of these were en-
rolled in the first and second year of advanced army courses.
Twenty-five students completed the army ROTC requirements at
Howard University during the year 1953-54. Nineteen of these were
commissioned second lieutenants of the United States Army Reserve.
Six others were scheduled to receive commissions as second lieutenants
of the United States Army upon the completion of summer camp
training.
Air Force Reserve Officers’ Training Corps—Three hundred
students were enrolled in the Air Force Reserve Officers’ Training
Corps during the school year 1953-54. Of these, 216 were enrolled in
the first and second year basic courses; 84 were enrolled in the first
and second year advanced courses.
At the close of the year, 19 students were commissioned in the
United States Air Reserve, 15 were commissioned in the Air National
Guard, and 2 were awarded certificates of completion. Assignments
of these officers will be made to fill worldwide Air Force vacancies.
FACULTY
The university was served during the school year 1953-54 by 429
regular teachers. Two hundred fifty-two of these were giving their
full time to the university, while 177 were serving in various part-
time capacities. Altogether they made a total full-time equivalent
teaching force of 292.7. Of this total, 268 were in the rank of instruc-
tor and above, 22.7 were below the rank of instructor; two others were
serving in the Junior School of Music. i
Fifty-four of the 177 part-time teachers served the university with-
out compensation.
COMPOSITION OF THE FACULTY |
The faculty of Howard University is composed of Negroes and
white persons, Northerners and Southerners, Jews and Gentiles,
Protestants and Catholics, persons from Europe and Asia, North,
Central, and South America, and from Africa.
ff
)
Howard University 267
From the beginning of its work in 1867 it was a major purpose of
the founders of Howard University to employ Negro teachers, among
others, on every faculty. Today the Negro members of the profes-
sional faculties of Howard University, exclusive of religion, consti-
tute together a group of Negro professional teachers larger by far
than all the Negroes so employed in all other American universities
combined. The existence of this group of Negro university teachers
at Howard University has been a standing inspiration to the Negro
people for more than three-quarters of a century, and membership on
one of these faculties has been the first employment of many of the
most outstanding Negroes in the public life of America.
BUILDING PROGRAM GOES AHEAD S
The new building for the College of Dentistry is approaching com-
pletion. The present aged and deteriorated building is now crowded
to the point of maximum congestion, so that both students and faculty
are looking with eagerness toward the day when they may enter the
new and modern facilities now soon to be available in the new building.
It is expected that the new building will be ready for occupancy at the
beginning of the second semester in the school year 1954-55.
Contracts have been awarded and construction has begun on three
additional building projects as follows: The Pharmacy Building and
the Biology Building; and work is well underway toward the trans-
formation of Thirkield Hall into a modern building for Physics.
When these two last projects are completed, Howard University will
possess three thoroughly modern buildings, with modern and adequate
equipment for work in Physics, Chemistry, and Biology.
In the month of June the Congress of the United States appropri-
ated $4,436,000 for the construction of a new preclinical medical
‘science building. The plans and specifications for this project are well
underway, and the contract for the erection of this building will be
awarded as soon as the present aged and deteriorated building now
occupied by Dentistry and Pharmacy can be demolished. When the
building erected from this appropriation is completed, Howard Uni-
versity will possess modern building and equipment facilities for
1,000 students in the medical professions as follows: 400 in medicine,
400 in dentistry, and 200 in pharmacy.
HIGH CALIBER OF FACULTY AND STUDENTS IN THE COLLEGE OF
DENTISTRY
Five members of the faculty of dentistry were engaged in graduate
study during the school year 1953-54 in the fields of orthodontics,
prosthodontics, oral surgery, operative dentistry, and pedodontics.
When the faculty of dentistry enters its new building in 1955, more
268 Department of Health, Education, and Welfare, 1954
than three-fourths of its members will have engaged in specialized
study beyond the D.D.S. degree. Their competence for the work to
be performed in the new building will be outstanding among the
faculties of dentistry in the United States and Canada. A special
appropriation by the Congress of the United States will enable this
eminent faculty to enter the new building with a close approximation
of adequacy in nonteaching personnel, so that from the very beginning,
their work may be expected to go forward with great facility and on a
very high level of qualitative performance.
Highty-five percent of the entering class of 50 in the college of
dentistry during the school year 1953-54 held the bachelor’s degree in
the arts and sciences, and, of this group, 8 percent held master’s
degrees. Over a period of 10 years an average of 63.7 percent of the
graduates of the college of dentistry of Howard University have been
holders of the bachelor’s degree. ‘This compares with an average of
28.2 percent for all the dental schools in the United States during
the same period.
The graduates of the college of dentistry are prepared not only to
do their work in dentistry with a high degree of competence but their
broad liberal education enables them to participate as citizens in public
affairs and public services with wide and discriminating understand-
ing of that which is excellent, and with a generously appreciative
cooperation with their professional colleagues and fellow public
servants In every area.
GRADUATES
During the school year 1953-54, Howard University graduated 571
students from 438 States, the District of Columbia, and 16 foreign
countries. ‘These graduates were distributed among the 10 schools and
colleges as follows: liberal arts, 261, of whom 124 were graduated with
the degree of bachelor of arts and 187 with the degree of bachelor of
science; graduate school, 38, of whom 18 were graduated with the
degree of master of arts and 20 with the degree of master of science:
school of music, 25, of whom 14 were graduated with the degree of
bachelor of music education, 10 with the degree of bachelor of music
and 1 with the degree of master of music; school of engineering and
architecture, 39, of whom 7 were graduated with the degree of bachelor
of civil engineering, 6 with the degree of bachelor of electrical engi-
neering, 8 with the degree of bachelor of mechanical engineering, and
18 with the degree of bachelor of architecture; school of religion, 5
with the degree of bachelor of divinity; school of law, 29 with the
degree of bachelor of laws; medicine, 60 with the degree of doctor of
medicine; dentistry, 45 with the degree of doctor of dental surgery
and 6 with the certificate of oral hygiene; pharmacy, 25 with the
Howard University 269
degree of bachelor of science in pharmacy; and social work, 83 with
the degree of master of social work. During the year the university
also awarded 4 honorary degrees which were as follows: 1 doctorate
in humane letters and 3 doctorates in laws.
During the 87 years of its history, since 1867 Howard University
has graduated 18,195 persons.
By far the largest number of these graduates are engaged in the field
of teaching, primarily in building up a system of education in the 17
former slave States. Two thousand six hundred and fifty-eight have
entered the practice of medicine, 1,196 dentistry, 1,535 law; 752 have
entered the ministry, 755 the practice of pharmacy; 489 have entered
into engineering and 264 into the field of social work.
These graduates are at work in 43 States and 27 foreign countries.
In every population center in the United States they constitute a
cross section of the leadership of the Negro people. Together, these
graduates constitute the largest and most diversified group of trained
Negro public servants related to any single institution in the world.
In the eight professions of medicine, dentistry, pharmacy, engineer-
ing, architecture, music, law, and social work, they include a body
of Negro professional graduates larger than the output of all other
universities of public and private support combined, in all the South-
ern States.
SERVICE TO FOREIGN STUDENTS AND IN FOREIGN COUNTRIES
Howard University has developed a far-reaching service to foreign
students. Foreign students are now enrolled from 44 foreign coun-
tries, island communities from the West Indies and the United States
possessions. It ranks third among American universities in the per-
centage of foreign students enrolled.
The student body is drawn from four continents of the world. They
are representative of every race and color in the world. Three thou-
sand five hundred and four of them are affiliated with 34 different
religious bodies—Protestants, Catholics, Jews, Moslems, Hindus,
Zoroastrians, Buddhists, and Bahaists.
Howard University students and teachers have associated daily with
teachers and students representative of every race and color, and
many of the major creeds of the world. They have learned by ex-
perience that the common country of the trustable human heart crosses
and transcends all these boundaries of external differences, and they
are habituated to a friendly interest in human beings everywhere. In
recent years many of those teachers and students, as individuals and
in groups, have traveled on missions to many countries in Europe,
Asia, and Africa; as now in India, Iraq, and Indonesia, so wherever
they have gone, they have imparted good will and friendship and they
have found good will and friendship in return.
270 Department of Health, Education, and Welfare, 195. 4 : 4
Again and again the responsible leaders in Government and the
friends of America have acknowledged their services as being of the — 1
greatest value to their country and to the cause of democracy in the
world. |
a
Detailed Contents
THE SECRETARY’S REPORT......__........___.
THE DEPARTMENT AND ITS WoRK-_-_--- ee, De Letter eee se bee
ME A Dee Cea eee ee a IOS I VE Se
SES etal oF gy 5 ie eg ie lg ip a leh lll ld din ale
irenorsnts In WDUOATION. 2-2-5.
Peeerermernie-1y VW ELMAR lo ilo ell
TABLE 1.—Grants to States: Total grants under all Department of Health,
Education, and Welfare programs, fiscal year 1954__________________
SOCIAL SECURITY ADMINISTRATION
Seer OuU RIT Y TN. 1954... 6gt io! teuie pols Mange fo!
OLD-AGE AND SURVIVORS INSURANCE.---_------------------
Tum SIGNIFICANCE OF THE PROGRAM_._..__-.____-___-___-_ eee
Benenuciaries and Benefit Amounts__..._-__-__._._. i Leese lll
BeMmCneTION PIOVIGNGs 4 et ty cheek dessa eee dh eb eek
SEE? FOCTAI oo oe dele eis Swe a oe we
Contributions and Disbursements____________________________________
pememumermoe the Program. _.............-..- Se CUAL Ie de
IMPROVING THE PROGRAM—THE 1954 AMENDMENTS__________________-
Re Arey i eee ee et eee
Re oe a ie ee
Lil i gag Oa = a a a ae
PGT eCrADY 20 fe cae ee eee oe eee
ee eS PANO Bie bE he ioo een wleud be sole bie
eee AND TOXPENDITURNS..2 0 ee ee ee
EFFrect oF OLp-AGE AND Survivors INSURANCE ON PUBLIC ASSISTANCE_.-
Paes UR LOPMONTS.. 202 eo Sota ee A Lee ee es
Services to Aid to Dependent Children Families___________.__-_-------
Emphasis on Rehabilitation and Self-Care___._..._.....-.-------.------
Standards of Institutional Care for the Aged, Blind, and Disabled _-------
Public Inspection of Public Assistance Rolls___-_...----_-------------
PPIWIeeR ATIVE. OPPRATIONS =~... oo ee ne ee ee ee
Review of State and Local Operations___.__._.._........----------------
pee eG UDICATIONS._____._..- 6 own ee ee BeOS eee EL
Technical Assistance to States_...............--...----.---..----=----
Recruitment, Selection, and Training of Public Assistance Personnel----
271
272 Department of Health, Education, and Welfare,
CHILDREN’S ‘BUREAU 222 224624 oe 2b ee! 2326 pees
PROGRAMS OF THE BUREAU. (2.2) ie 2 2 55 ee ee eee
The Research Program... 22 ee
Grants to the States___.-_...._. 2 te ewese ss oe oe Jae
Maternal and Child Health Services______________-____-__----_-_--
Crippled-Children’s.Services....u..222:...../22 35-24. 2
Child Welfare Services._._......--...-L.-..--.._... 4. ee
~The Program of International Cooperation______________--------------
Publications... . i220 2- 224055225562 ccs ewe ee ee
TrRENDs AFFECTING CHILD Lirm_._..__.....-_1.1.-s24...5 ase
Parents’ Groups__...-.-5. 2222 oes eee cee
The Whole Child..-2.0..¢-2.--- 52-2560...) 3225)
Social Services to Children in Their Own Homes---_.--__-.-_------
Adoption... 2... ns 2 SER ee ete oe oe
Group Care for Children.__-.....02_+...:_-.-_....4.
CHILDREN Wits SprciaL NEEDS. _..__....-..2.._...... 4
Juvenile Delinquency. o't22 Yigal tl). see
Mentally Retarded Children......._....-.-.-.-.----1..5.22
Children of Migratory Agricultural Workers. __________-._----_--------
Black Market in Babies... ..u0..--.-.22-4.--s...-3.-33. 2 on
TABLE 1.—Social Security Administration: Funds available and obliga-
tions incurred, fiscal years 1954 and 19538_____.____..-.-_-__.-----.-.
TABLE 2.—Financing social insurance under the Social Security Act: Con-
tributions collected and trust fund operations, fiscal years 1952-1954__-
TABLE 3.—Old-age and survivors insurance: Estimated number of families
and beneficiaries in receipt of benefits and average monthly benefit in
current-payment status, by family group, end of June 1954 and 1953___-_
TasLe 4.—Old-age and survivors insurance: Selected data on benefits,
employers, workers, and taxable earnings, by State, for specified periods,
1952-1954... co led be bee bs ao
TaBLE 5.—Old-age and survivors insurance: Selected data on benefits,
employers, workers, and taxable earnings for specified periods, 1952—
TABLE 6.—Special types of public assistance under plans approved by the
Social Security Administration: Number of recipients and average pay-
ment, June 1954, and total payments to recipients, by program and
State, fiscal year-19544 2 sesccccce rel noe ow eos: eae er
TaBLE 7.—Special types of public assistance under plans approved by the
Social Security Administration: Federal grants to States and total ex-
penditures and percent from Federal funds, by program and State, fiscal
year 1954.02 db lee eee eb let ee
94
95
96
98
Detailed Contents
TABLE 8.—Maternal and child health and welfare services: Grants to
States for maternal and child health services, services for crippled
children, and child welfare services under the Social Security Act, by
Pemorummand tate, fiscal*year 195422292202 22 flict ice
TABLE 9.—Federal credit unions: Number of members, amount of assets,
amount of shares, and amount of loans outstanding Dec. 31, 1935-1953 -
TaBLE 10.—Federal credit unions: Assets and liabilities, Dec. 31, 1953,
PU intl LO Pi ll lac) ne ae a id eee ap ree el eg ao
CuHart 1.—Coverage has been extended to 10 million more persons- - - __-
Cuart 2.—The 1951 relationship between earnings level and the earnings
Mummrreenoeen TeStOled.. «2 5-5-2 on ee ee 8
CuHart 3.—Benefit levels have been increased_________--___-----------
CuHart 4.—Average monthly assistance payments, June 1954___________-
Cuart 5.—Proportion of population receiving assistance (recipient rates)
mecdeeo ried states, June 1954_— 0-2 Ss l alee el eee
CuHart 6.—Growth in social insurance protection for the aged_____--_----
Cuart 7.—Number of children receiving aid to dependent children with
father dead and number of survivor children receiving old-age and
Mr ors insurance, 1950-19542... 2. 2 2 ee eo ----a-e-
Cuart 8.—Children in the United States are increasing rapidly_________-
Cuarr 9.—Children in foster family homes increase as children in institu-
TEAS EBT a ia ae ee GE Re
CuHart 10.—Juvenile court delinquency cases are rising_____.._----------
CuHart 11.—Prevention of prematurity and better care of premature babies
would greatly reduce mortality in the first month of life-____________---
PUBLIC HEALTH SERVICE
Ma LiitnN ATION (2c 0522 25 2-2 lel i --aeo-- ae
MEINE Se er ph a ee SER ele
Births, Marriages, and Divorces- ---- STR Pedder ee te BANG Se SA to PR ON NR ogee Ne
pment Ie SONNBE 208 Le ek ee eee
Perret MmERGCENCY PLANNING. .22_.2.2 2 222 2 eee eee ee
Meee rH OVI ETHODS...... 22 a2n ee oe ew we ee LA sete el Jae
ieniveen tanpower source. Books.._..2.2....-.-..s22 20 Sel eh AN
Reemeermrrrervices and Pacilities. 2 2.222) kes lee eee eee eek
Se cies Of hiiness. 2 ee ee Or
Penal INSCITULTES OF HRALTHs.... <2. 2222. 2ole8le ete.
rrr G WNT oo ee SP Vee Ok Berea ye. L
Beemer AOrauory. 8 Ae Se tue eee 2
RESEARCH GRANT AND FELLOWSHIP PROGRAMS..____________-__-_-------
Pewee rents ProoTam .. cinsewu lS Se does eball woliuessitous Ace
ARTHRITIS AND METABOLIC DISEASES... 230 2 ee eee
DTM CECSS 2 ee epee
erenten Grants and Some Results. v2
Carer RESEARCH AND GCoNTROL:&: oc ek eee eee sce ee Pe
Pererarory and. Clinical Studies. 22222 22-- 2 5.- ewer eee ate
Reemennre eal Uldies. 2. 2. S22 oe ee be pentose
273
Page
100
101
101
24
31
32
39
42
45
47
61
69
75
81
103
103
104
104
105
106
106
106
107
108
108
109
109
110
111
111
112
113
113
114
274 Department of Health, Education, and Welfare, 1954
' Page
Support’ of Research and Control. : 222. [U2 De ew) eee 7S Ss
Studies Supported ‘by Grantss- 0021 i ieee _ lee ee A ae 114
DENTAL RESEARCH... 2 2 oo Se i a 115
HEART AND CIRCULATORY RESEARCH..____________-___-_------------- 116
Research Advances at NHToue 2222 2 Sh 2 a ee eee 8 AOS 117 s
Research Grants Accomplishments__________________-_-_----------_- 118 ¥
MENTAL HeaLrae ooo Uo a 119
Research Programs of the Institute._________-_____--_--------------- 119 s
Institute-Supported Research: 20.2222 S022 LL ul lel lil Soe eee 120 F
Mental: Health Statistics... 2 pw eee 120 4
Community Services..........._..J222 iS LO ea eee 121 =
Professional Orientation 222.0222 Eee ee eee eee 121 j :
MICROBIOLOGICAL RESBARCH...__..-2..--.-._-<.~-_- 5-4 121 i
Research Grants... 2.0622: set cise e ee pees ns Ieee 122 a
NEUROLOGICAL DISEASES AND BLINDNESS___-___---------------------- 123
Research Grants Accomplishments__- 2-2 -_____-__ 2 2 123 |
BUREAU OF MEDICAL SERVICES. 220223 Jucla_. edi ad eee 124 i
Hosrirats any “MEpican Carn? 220° ooo) Se ee eee 124 3
Volume of Services... .-.. 22 20 125 :
Special Hospitals. 0. 2 125 #
Clinteal Research oo er 126
Professional Education. —- oe el te el 12é *
Freedmen’s' Hospitals. v2.4. fe eS eee 127 .
HEALTH PROTECTION AT Ports AND BORDERS____________------------- 128 :
Medical -Examinations_. ..0..22.-.--2-2-..-_-1. 5 128 cf
Special Problems... 00 2. 02.2 oe ee eee oe 129 i
Services for ‘Travelers J. 2s oe 129 4
HospiraL SURVEY AND CONSTRUCTION. -.-2_2 5.25. 7 oe 129 iy
Meeting Present and Future Needs____._______._-_--.-_--.---------2- 130 #.
NursIna Resournces.2...-0.. 2-220 eee 131 i’
Training of Nursing Aides.__..2..2-42-.2 isc -s2..s-)J03 See 131 ;
Studies of Nursing Activities...._.._..____._._ciend oo 131 ;
DENTAL RESOURCES, 22222 6b 2 22522 ee eee 132 i
Utilization and Supply of Dental Services.__......_._......-___------_- 132 .
Special Dental Studies... Se i a 133 ;
MepicaL SERVICES FOR FEDERAL AGENCIES__.__-___._-__------------ 133 7
Office of Vocational Rehabilitation.....-....__......_.i ss. 133
Bureau of Employees’ Compensation, Department of Labor____________- 133
Bureau of Indian Affairs, Department of the Interior___.....__.._-____- 134
Maritime Administration, Department of Commerce_________________-- 136
United States Coast Guard, Treasury Department_______.___.-.--__--- 136 Z
Foreign Service, Department of State................-_--2n-JicbL ee 136 i
Bureau of Prisons, Department of Justice.._....__.. ____. oe 137 -
BUREAU OF STATE SERVICES....__.___... 4. 2 iss
GUNERAL, Heattrs, SERVICES... 22425. 22222. alu ele 138 e
State Grants Services.<2.2-0-222ccecee-e-ceaecceecs ce UD 138
Detailed Contents
Papue tieaicis Education pervices.... oS eons
Se eetraaitn Nursing Services... ~~. oo ot ee ewe
National Office of Vital Statistics______ Be eo ae i ent ae
meereoreaitn research Center. 200 oo Le
femisiOn OF SPECIAL HEALTH SERVICHS...___-_-_.2- 2b 2-22 Ll tle
Ice Ee OUTa ete eye Te ee ee ae
Ceermerinehes FTORTAaNY.- Lk ee ose
nee ieniil Proprany. 0) ee a ee
meretosis Control Program. 0 eee
Suen eonse Contro, Program. 02 0 ee sil.
Panicany ENGINEERING SERVICES.__.__..._.~--_ 2 -ieend-5-2--5+-4-
muemrrasieinecring Center..._.__._..-.-.-------- ee bwin tetas
Se errerteCAlt hee eh eal foetal ae
Water Supply and Water Pollution Control.________------------------
eeratate a-atrier Panitation...........2...2-_..-.2..--.2.---. abbas
menersn oneinecring. Activities... --.--1-2--2-J---- 45-2. suede
Puen OOd. panitation....- eee eee eo
Peemesccident Prevention...._.....=.--.-----.---...--.- Ee poor ce Shand
PMIIMG Pre OUSINT 0000 ogres ued pouh iad joe oe sepals
PemrTcantey DISHASE CRNTER.WU 22. Le
MINN OCRVIECR SO. et ee ee ee ee
Sa Sat ss ci i ap eee
emma fo MA CUVItICs oo no ee eee tens
Development of Equipment and Control Methods-_-__--__._-------------
TIE AERC ie oe i we oe
IT ONY fo Mi el hn oe a a ie ee
Division OF DentAL Pustic H®ALTH. 2.2L eel ee eee lk
TEU WOU iL ied ee ee be ee eset eevee
Field Project Activities__._._____- He sociale sly et ck i i hag ey a aR
IIVISION OF INTERNATIONAL HBALTH._~..-__--~_.-.--~__ ea
Wolta River Basin Development... 222-4. 22-0). 2--- enol eles Lessa t-
STINT CES ES I gl a ae ace ee ee ee
Meer orcign Nationals... . +... -.2.-..-+-..---...--.-.----
TaBLE 1.—Statement of appropriations, authorizations, obligations, and
balances for the fiscal year 1954_............-.------ Sa epee eee
TABLE 2.—Commissioned officers and civil service personnel as of June
I Pe tis oo io a See tee eee eee eet OOd S200 UL
TABLE 3.—Payments for research grants, research fellowships, and field
investigations and demonstrations, fiscal year 1954___..____----------
TABLE 4.— Payments for teaching grants, traineeships, and training grants,
TN a rs ares Sea wis otras Pa ig OS
TABLE 5.—Payments to States, fiscal year 1954_________--------------
OFFICE OF EDUCATION
SEPMEE Re TT Ey NGies trie ke 2 EDC eu ha! we ea eh Te a eee Bile
II. Mason EpucaTIONAL PROBLEMS CONFRONTING THE UNITED STATES IN
276 Department of Health, Education, and Welfare, 1954
Page
The Need for More Prepared Teachers and More Buildings Is Accented
by. a: Backlog of Deficiencies. .........------- +445) 4-25.30 0 ee 176
Shortages of Teachers, Scientists, Nurses, and Other Trained Personnel
Is Aggravated by the Loss of Potential Resources_-_--__.-_---------- 178
III. Services To EpucaATION IN THE UNITED STATES_________-_------ 181
State and: Local School Systems_.2....2...2-2.._.L.._..-.4 182
State: School Administration 2... 2... 2 er 182
Local School Administration.___._....__-._.....42_ he 182
School Finances... <1 -12.2.--4.---.2+- st ee 183
School Legislation.....---....2-..2..2.-2-n. er 183
School Facilities... ......-22..-.+-..2:--L._.-....2= 184
Elementary Education = ==-<2-obo. wie ie A re ee
erareand, LocaliAdministration «ich .0es tawlucs Sh bee ee ol lew tt
Coordination Among Public Agencies________________-___-_-__---
emer On DIStratlone <2 .2\. 24.26 eben eo eee Lee
Amendments to the Randolph-Sheppard Act__.-________________---
Tete eG lOO Liss so oo ee a ee ee ee ee ah eae ae ees
WActrities AND SERVICES FOR THE DISABLED____..__..-.......-..-.-.-
fier ove—rederal Partnership---..25 29.20. 22 2 ble el ett
ieemeroervices for the Disabled_........_..-_._-----.--+-.--.---=--
Beer mrCeeLOrations ee a Ye ee ey ee 2 Pe
Progress in Meeting Unsolved Problems__-___-___------------------
Peewee a Oly CONGGrs oui sae eheseese an desusdcusesaees Oe
Pee ero tH STATES. 5002 e oe ee ee ee eee eee
Pome aC LFOSTAM 6020 5. So ee eee eee ate
Stimulating Employment of the Handicapped_--___-_____---_--_--------
The Vending-Stand Program for the Blind__________--__------------
Facts AND Fiaures ABoutT REHABILITANTS________________________
Characteristics of the Persons Rehabilitated.________________________-
meverrove. )hat Rehabilitation Pays....45-.0.04-<+ a.+--2+4--42be-2-
Dr enna OPH ER. NATIONS 2c 6 2a oon ce ede ce ee ek edbe sec cesses eee deed?
Tue District oF COLUMBIA REHABILITATION SERVICE________________-
TaBLE 1.—Number of referrals and cases, by agency, fiscal year 1954__-__
TaBLE 2.—Total program expenditures from Federal and State funds for
vocational rehabilitation by State boards of vocational education, fiscal
er eee ee eee eh en EN ee Stee
220
220
278 Department of Health, Education, and Welfare, 1954
Page
TABLE 3.—Total program expenditures from Federal and State funds for
vocational rehabilitation of the blind by State commissions or agencies
for the blind, fiscal’ year 19542 22220 2 2 loll oo ai ee 243
CuartT 1.—Disabilities and major occupational groups- __-__..--------- 235
SAINT ELIZABETHS HOSPITAL
Diviston or MEpIcAL SERVICES... _.-_.°_.-._-5__-2221___2 i ee 245
Clinical, Branches... ..-—~-4;.5-5-2- 4-4) ce ate Ss 245
Medicine and. Surgery,Branch.. 5... --<2.-cu-405~--->5e eee 249
Psychotherapy Branch... 50 hese eco ae eo ee 249
Laboratory. Branch...22.-504-20-'-+.- 2 ee 250
Nursing Branch. 2.20.0. -2-2 2h 2n se ok oe ee 251
Occupational. Therapy Branch... 215 .2..-4-2---- >... oe a 251
Social Service Branch. .....-2- oe nk ee 251
Chaplain Services Branch... ...-...22..__-.....-....L 1 252 .
Library Services —~ - ecq-ye me oe oe ein ee ee ee ee 253
Special, Services doatancu ee ieee eee eum er cnn Era Beppe Feil 253
Teaching Activities. oo ..-.0- 0.022 Lo oe 254
GENERAL ADMINISTRATION... 00 0.0L 22 oh oa 254
NEDSS OF THE HOSPITAL. ......-..--1.2.,---.......- 528 257
TABLE 1.—Patients, admissions, and discharges, fiscal years 1935-54_-_.-- 257
TaBLE 2.— Movement of patient population, fiscal year 1954______...___ PARK
TABLE 3.—Consolidated statement of movement of patients, by classifi-
cation, fiscal year. 1954___......-1.....-...... 100 ee 258
AMERICAN PRINTING HOUSE FOR THE BLIND
Services to Schools and Classes for the Blind______________._______-____- 259
HOWARD UNIVERSITY
Enrollment of Students..:.2 226222222325 /50 a2 eee 263
Geographical Distribution of Studeétits__.-. = 263
The Comprehensive Purpose of Howard University_____.._____.------- 264
Highly Significant Service to Negro Students______._______._---__----- 264
Woeterans 2 ooo Se ee re i ee 265
Army and Air Reserve Officers’ Training Corps_.__.___.___.-.--------- 266
PaCUliv oe oe ee en eee 266
Composition .of the Faculty--2_ 7 a 266
Building -Program Goes Ahead «2:0: kc ee 267
High Caliber of Faculty and Students in the College of Dentistry______-_- 267
Graduates. 2 ico ec oe a ee aS 268
Service to Foreign Students and in Foreign Countries______.._.-_---_-- 269
U, S$. GOVERNMENT PRINTING OFFICE: 1988
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